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Jan 081511:34a p.3 <br /> San Joaquin County �C��� / (�� <br /> Environmental Health Department �/ E <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> 7-elephone:(209)468-3420 Fax:(209)468-3433 Wa6:MLW si„gov.or./� JAN 0 3 2015 <br /> RETURN TO COMPLIANCE CERTIFICATIOW!RONMENTAI <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 in5poction. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of Uiis form within 30 days of receipt of the Inspection Report. HSC 2b404 1.2(C)(1) <br /> NI 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 /> nspection 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 resultslmanifests/training recordslother appropriate paporwork• and/or photos verifying <br /> corrections <br /> Inspection Date: December 12, 2014 inspected By: ELENA MANZO <br /> Facility Address: 1950 E SIKORSKY ST, STOCKTON EPA ID: <br /> 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 /> -Photos 1✓ Paperwork ✓ 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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name:�e6v SKS Title:/I�AI <br /> Sianature: Date: l" � ��� <br />