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FNI FPX NO. ug. 10 2015 03:19PM P1 ul) <br /> San Joaquin County <br /> Environmental Health Department GEIVE1 <br /> &vukLvit, Onlifornia06206 6232 <br /> 1868 East MazeltQn Avenue, <br /> Telephone:(209)468-3420 Fax:(208)468-3433 Web:WMA901911110—hd AUG 10 2015 <br /> RETURN TO COMPLIANCE CERTIFICATIOWNVIRONMENTAL, <br /> '-'CA'-U`1C:0A0T4#F:hj-r <br /> Any NINM violations noted in the"Notice to Comply" in the attached Inspection Report must be CgrreqW wifllia 30 dW of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Deportment(EHD)address <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All cora gbLon <br /> A19 other MigLationo,noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> vj%j1ctCj%oj to, imm to W,*eubmK**a U4211"10 Tmes%tirknand mtsmad to r=HD within 30,dus unless otherwiise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHID staff time associated with failing to comply by the-above noted dates will be <br /> billed at the current hourly rate. <br /> ' tis" _"� feb 6,&. c-.^MpICMt45, u.--_t- _r <br /> A statement documenting what corrective actions were taken or will be taken for each violation rrectio <br /> Copies of sample resufts/manifestshmining recordsiother appropriate paperwork, and/or photos verifying co ns. <br /> Inspection Date: July 15, 2015 Inspected By: CINDY VO <br /> Facility Address: 515 W ELEVENTH ST, TRACY EPA]11. <br /> I certify under penalty of low that <br /> i. I howo oprroatod tho V1010titionv Ippecifiad in the Inapaction Per.-tart from fh^nhewo-mantinnari ins trim inn&kfp- <br /> :z., i have pevve.impliy o-viRmitiml trif+tr tile wwrau Lit 1[:j it I jrr 11,Wlit ,I ...titav init-ti am. it uur ur ron EAci i vIOLATION <br /> I 0011fiVU LF149 IffIVININSLIU11 LU L.TW UUW,CF.s4W10W.Car au kAJ111FICLIM. <br /> t%1 <br /> tinotos tSperWOrK ._r, *mTement <br /> 3, 1 am authorized to submit this certification on behalf of the Respondent. <br /> A i-- ouporim that thnirozmaianifie-ont ru%nnitioba fe%rciiKmiftinofs%1ct#%inmrmminn. inn.lioina thp nnr_qihiftnfqfins Mnfj/r <br /> imprisonment for known violations, (HSC 25191) <br /> Name: L-e v e,4--0- 1rdia. ha J;S-t q A r fileY 14 0 <br /> L <br /> Signature: Date. x571 6 ZI <br />