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SAN JOAQUIN COUNTY 9— <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 .�R�: (' <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web: jgoy.orgLghd <br /> SEP 10 ?_014 <br /> RETURN TO COMPLIANCE CERTIFICATI(DWIRONIIE'„`”,;.�L HEALN <br /> 0Ep.A p�' ,A.EN <br /> Any MINOR violations noted in the "Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Heafth Department(EHD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report. HSC 25404-1.2(c)�1) <br /> All coaQdons to other violations note in the attached Inspection Report(IR) or Continuation Form, or <br /> disputes to any virions, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourlrate. <br /> For 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 resultsimanifests/training records/other appropriate paperwork,and/or photos <br /> verifying corrections <br /> • <br /> Operator's certification <br /> Inspection Date:August 25, 2014 Inspected sy:Fatinah Zareef <br /> Facility Address:6131 Pacific Ave, Stockton EPA ID#: UL00034 b71 <br /> I certify under penalty of law that_ <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date- <br /> 2. 1 have personalty examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 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, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: v L( Title: lu <br /> Signatures-' L! �/�l �/ /�r� Date: <br /> EHD 22-02-005 Rev 04119+12 <br />