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Ij <br /> /X n��l SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT RECEIVED1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telep one:(209)468-3420 Fax:(209)468-3433 Web:www.si-ov.org/ehdMAY O <br /> 7 2014 <br /> EWRON <br /> RE URN TO COMPLIANCE CERTIFICATI IV R""M SERVICEENTAL SLTFI <br /> Any MINOR violations n ed in the "Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days f receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health De artment (EHD) address at the top of this form within 30 days of receipt of the <br /> Inspection Report. HSC 5404.1.2(c)(1) <br /> All corrections to other vi lations noted in the attached Inspection Report(IR) or Continuation Form, or <br /> disputes to any violations are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specifie in the Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff ti a associated with failing to comply by the above noted dates will be <br /> billed at the cu ent hourly rate. <br /> For this certific tion to be complete the operator of the site must include: <br /> • A statement docume ting what corrective actions were taken or will be taken for each violation <br /> • Copies of sample re ults/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certificatic n <br /> Inspection Date: -4 1 / 14 Inspected By: <br /> Facility Address: EPA ID#: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected t e violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally xamined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> X Photos K Paperwork r _Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that th re are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Title: &IAe. ulArT- T�cW, <br /> Signature: Date: d--2-1Y <br /> EHD 22-02-005 Rev 04/19/12 <br />