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SAN JOAQUIN O.UNTY <br /> ENVIRONMENTAL HEAL rHbEPARTMENT <br /> 1868 East Hazelton Avenue, Stoc ton,California 95205-6232 .: <br /> Telephone.(209)468-3420 Fax:(209)4 38-3433.Web:www.s' b I D <br /> RETURN TO COMPLIANCE CERTIFICATIONJUN 19 2014 <br /> Any M INOR.violations.noted in the"Notice to Comply" In the attached InspectiWWQ"WAL HEALTH <br /> corrected within 30 days of receipt of this inspection. This certification form must be sG1f Rit>r B"T <br /> Environmental Health Department(EHD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report. HSC25404.1.2(c)(1).' <br /> All corrections to other violations noted in the attached It spection 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 specified in the Inspection Report. HS 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 /> Fo thiS Certification t0 be cor"IllplOtlil the operatorofthe site,mustInclude: <br /> • A statement documenting:what corrective actions re taken or will betaken for each-violation <br /> Copies of sample results/manifests/training records other,appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date::May 1.5, 2014. Inspected By:Garrett Backus <br /> Facility Address:419 S Mani St, Manteca EPA ID#: CAL000364723 <br /> certify under penalty of laity that: <br /> 1. 1 have corrected the violations specified in the In pection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following docti i ntation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be.true, accurate, a d complete:. <br /> Photos Pap iwork Statement <br /> 3. lam authorized to submit this certification on bet ialf of the Respondent. <br /> 4. 1 am aware that.there aresighificant penalties fo submitting false information, including the <br /> possibility of a fine and/or imprisonment for knoiA n violations. (HSC 25191) <br /> Name: An/lfF Title: AL,tan-1^ <br /> Signature: Date: _ <br /> EHD 22-02405 Rev 04/19/12. <br />