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To: Robert Lopez San Joaquin County Env Page 36 of 36 2020-01-10 02:16:45(GMT) 12093709559 From:Griffin Materials <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420.1*ax:(209)468-3433 Web:www.sjgov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report.must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EMD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> 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 hourly rate.. <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 resutts/manifests/trainina records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: June 16, 2017 Inspected By: ROBERT LOPEZ <br /> Facility Address: 248 W INDUSTRIAL OR, STOCKTON CERB ID: 11)'IA40,1,144 <br /> I certify 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. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate,and complete: <br /> w," Photos —'-" Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information,including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name:= i i }- c fZ,v a_ C i rz a TitIe: e`r" r} c-r-V, .. <br /> Signature: Date: .�4P I__ _11iM <br />