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FROM NO. Jul. 1 16 12:24PM P1 <br /> L <br /> LSan Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton,Califomia95205-6232 JUL 15 2016 <br /> TelePhone. (209)4e&3420 Par, (209)468-3433 Web-www.sio2y.orQ/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION- -- <br /> Any MINOR violations noted In the"Notice to Comply"in the attached Inspection Report must be Corrected Within 30 dans Of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(F-1­10)address <br /> the top of this form within 30 days of receipt of the inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections top 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 EHDvA unless otherwise specified in the <br /> Inspection Report. HSC 25186(c)(3) <br /> Note: All EH D 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 betaken for each violation <br /> Copies of sample resuftstmanifestsftraining records(other appropriate paperwork,and/or photos verifying correction.- <br /> Inspection Date: July 12, 2016 Inspected By: FATINAH ZAREEF <br /> Facility Address: 515 W ELEVENTH ST, TRACY EPA Ilk <br /> I certify under penalty of low that; <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 VIOLATION <br /> and I believe the information to be true,accurate, and complete, <br /> —Photos I- 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: 4-eii CopK Title:, rn -Rjtdvg,-fr_- <br /> Signature:_ 14k,— 0-6w< Date: --7 / Is-/le. i <br />