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I <br /> FROM FAX NO. g. 28 2014 03:41PM P2 <br /> SAN JOAQUIN.COUNTY RECEIVED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue,Stockton,California 96205-6232 AUG 2 8 2014 <br /> Telephone:(209)4M3420 Fax. (209)468-3433 Web:www.*iuov.oro/ehd <br /> EWIT HEALTH <br /> DEPARTMENT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 30 days of receipt of the <br /> 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 <br /> disputes to any violations, are to be submitted using this certification and returned to EHO within 30 days <br /> unless otherwise specified in the Inspection Report, HSC 25165{q)(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 /> 9 A statement documenting what corrective actions were taken or will be taken for each violation <br /> a Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> * Operator's certification <br /> Inspection Date: 7 19- 1 J P-1 Inspected By: MhCball-e- J4-*,nrY <br /> Facility Address: $1- -rrqq EPA ID#: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACHVIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos )41 Paperwork V- Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: . 14,e ki i!�OC?K TRW: �USI,$"xT Ma"R-er- <br /> Signature: Date- <br /> EHD 22-02-005 Rev 0019112 <br />