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San Joaquin County RECEIVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephoe: (209)468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehd JAN 11 2016 <br /> ENE "MsECSLTHRETURN TO COMPLIANCE CERTIFICATION PRM / RVIE <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 ce ification form must be submitted to the Environmental Health Department(EHD) address <br /> the top of this form within 30 daysof receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations n ted 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 t be complete, the operator of the site must include. <br /> A statement documentinghat corrective actions were taken or will be taken for each violation <br /> Copies of sample results/man ifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: December 15, 2015 Inspected By: FATINAH ZAREEF <br /> Facility Address: 1621 B OOKSIDE RD, STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. I have corrected the violati ns 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 /> I believe the information to be true, accurate, and complete: <br /> Photos XPaperwork , ' 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 possibility of a fine and/ <br /> imprisonment for known vi lations. (HSC 25191) <br /> Name: c Title: QnM0 IAA_)Lfr _11[c11- <br /> Signature: a Date: f — //—A6 <br />