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San Joaquin County <br /> 1868E t Environmental Health Department <br /> Tele h a S Hazelton Avenue,Stockton,California 95205-6232 <br /> P one:{209)468-3420 Fax:(209)468-3433 Web:www.siaov ora/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any !NOR v io la tion noted o to 'Notice to Comply"in the attached Inspection Report must be corrected within 30 days of <br /> receipto f th 15 inspection. Thts certification form must be submitted to the Environments! Health Department (EHD) 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 isputes o any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in th9 <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 hou ly 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 results/manifests/training records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: y. <br /> September 07.2018 Inspected B Nicholas Loehrer <br /> ___ _ _ __ ___ ___ p <br /> Facility Address: 575 INDUSTRIAL PARKDR CERS ID: 10155367 <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 /> X Photos x Paperwork x 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/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name:Megan Newman Heiden Title: Corporate Attorney&Compliance Manager <br /> Il' ✓1�Eunna�. ¢ ic4yii <br /> Signature: 4/30/20� <br /> Scanned with CamScanner <br />