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07/14/2015 17:18 5107563470 SHARMA PAGE 04 <br /> R'ep 4�9 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.ora/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply'in the attached Inspection Report must be corrected witW,i 3n 0 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address; <br /> the top of this form within 30 days of receipt of the Inspection Report. NSC 25404.1.2(c)(1) <br /> All corrections to 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 EHD within 30 days unless otherwise specified in the <br /> Inspection Report, HSG 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 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 results/manifests/training records/other appropriate paperwork, andlor photos verifying corrections <br /> Inspection Date: June 15 2016 Inspected By; ELENA MANZO <br /> Facility Address: 1711 E Yosemite Aver Manteca EPA ID: <br /> certify under penalty of law that: <br /> 1. I 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 /> I believe the information to be true, accurate, and complete: <br /> Photos Paperwork_Statement <br /> Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 airy aware that there are significant penalties for submitting false information, including the possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: s.t"' P#..M N Title: Cap <br /> Signature: Date: '7 14 15 <br /> RECEIVE), <br /> JUL 15 2015 <br /> ENVIRONMENTAL, <br /> IJr41TtJ <br />