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San Joaquin County <br /> Environmental Health Department <br /> 868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Teleph ne:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> RET RN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in t e"Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This c rtification form must be submitted to the Environmental Health Department(EHD) address <br /> the top of this form within 30 da s of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violation noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted u ing this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185( )(3) <br /> Note: All EHD staff ti a associated with failing to comply by the above noted dates will be <br /> billed at the curren hourly rate. <br /> For this certification o be complete, the operator of the site must include: <br /> A statement documentin what corrective actions were taken or will be taken for each violation <br /> Copies of sample result /manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: March 1, 2015 Inspected By: MUNIAPPA NAIDU <br /> Facility Address: 22525 S Airport Way , MANTECA EPA ID: <br /> I certify under penalty of law that <br /> 1. 1 have corrected the violtions specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally exam110 <br /> ed the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to subm t this certification on behalf of the Respondent. <br /> 4. 1 am aware that there ar significant penalties for submitting false information, including the possibility of a fine and/ <br /> imprisonment for known iolations. (HSC 25191) <br /> Name: Title: <br /> Signature: Date: <br />