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San Joaquin Courtly <br />iJrwiwnmenU Health DeparlInmert <br />'I lEarst'I areff m Avenue, Sfoct „ Cai�nnii��32 <br />y� axone: (269') 4f)&3420 1-m: ) 468-3433 We& www a'tapy:oro/etld <br />RETURN TO COMPLIANCE CEfit 11FIC:A`10N <br />Any MINOR violations rooted irq the'Noticie to CornM" in the attached lnspeotion Repod mast beammerted within 30 days of <br />receipl of tts inspeichm This ceriificztm forma must be submitted to the Environmental Health Depadment(EW address <br />ttae top of this loan within 30 d7o raempt oT the Inspection Report. HSC 25404.11.21c)(1) <br />AN corrections to other violations noted in the attached Inspection Report (1R) or Continuation Form, or disputes to any <br />violations, are to be submitted ng this certification and returned to EHDwithin 30 days unless otherwise specified in the <br />Inspection Report. HSC 251 (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 resulls/manifests/training records/other appropriate paperwork, and/or photos verifying correction! <br />Inspection Date: *11111. ",'O I,I <br />Inspected By: Al Vl_ I 0'4) <br />4 <br />Facility Address: �M )"�,l 1M I.— 11JA ► EPA IR <br />I certify under penalty of law <br />1. 1 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 VIOLAT <br />believe the information to be true, accurate, and complete: <br />_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 <br />imprisonment for known violations. (NSC 25191) <br />Name: Greg Buncab Title: Senior Env. Health & Safety Specialist <br />Signature: Date: _12/15/15 <br />ENt <br />DEC 14 21015 <br />ENVIRONMENTAL <br />Ur-AIrU nCOARTAACIUT <br />