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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telep one: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> RE URN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in he"Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This ertification form must be submitted to the Environmental Health Department(EHD) address; <br /> the top of this form within 30 d ys of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violation noted in the attached Inspection Report(I R) or Continuation Form, or disputes to any <br /> violations, are to be submitted sing this certification and returned to EHD within 30 days unless otherwise specified in the <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 curre t hourly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documents ig what corrective actions were taken or will be taken for each violation <br /> Copies of sample resul s/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: July 14 2015 Inspected By: Cindy Vo <br /> Facility Address: 1241 N EL DORADO ST EPA ID: <br /> I certify under penalty of law tha : <br /> 1. 1 have corrected the viol 3tions specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally exam ned the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to subit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there a e significant penalties for submitting false information, including the possibility of a fine and/o <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Title: <br />