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2098242683 MANTECA CRUISEPS <br /> PAGE 05/o6 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone.,(209)466-3420 Fax:(209)468-3433 Web:www&jgpv.oW hd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any' INO violations noted in the"Notice to Comply" in the attached Inspection Report must be Ql2grectedwithin 30 days of <br /> rec" t of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address i <br /> the;;;; p of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All rrections.,jo other violations noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> Viol' ions, are to be submitted using this certification and returned to EHL)Wabin-aQ dgyj unless otherwise specified in the <br /> Ins' ction Report. HSC 25185(c)(3) <br /> N All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> F this certification to be complete, the operator of the site must include-. <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training recordsiother appropriate paperwork, and/or photos verifying Corrections <br /> 1104 pection Date: April 21, 2015 Inspected By: ELENA MANZO <br /> F; cilityAddress: 1137W LATHROP RD, MANTECA EPA 0- <br /> I cl� tify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date, <br /> 2 <br /> I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 1 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, inrAuding the possibility of a fine and/c <br /> imprisonment for known violations. (HSC 25191) <br /> Name: ec,r Vy-,k Title- e, <br /> Signature: -Date: Ick -zol 5- <br /> C,\ W<:icY, ks er r5c;,- LC, Suq,CS <br /> RECEIVED <br /> AUG I J 2015 <br /> ENVIRONMENTAL.* <br /> !4r:A1-rwnC:DAQTCN17- <br /> -M-1 I <br />