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07/27/2017 20: 12 510796 470 SHi20-gH PAGE 03 <br /> San Joaquin County <br /> RECEIVED <br /> G <br /> Environmental Health Department <br /> 1869 East Hazolton Avenue,Stockton,California 95205-6232 J U L 2 8 2017 <br /> Telephone:(209)468-3420 Fax:(205)468.3433 Web:www.sigov.or0/ehd <br /> ENVIRONMENTAL HEALTH <br /> ENVIRONMENTAL RETURN TO COMPLIANCE CERTIFICATION ENVIRONME TlVIENT <br /> Any MINQR violations noted in the`Notice to Comply"in the attached Inspection Report must he ,corrected within of <br /> receipt of this inspection, This certiflution form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSG 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 ReportNSC 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/manifestsltraining recordslother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Inspection Date: June 30, 2017 Inspected By: JOHN ALANIZ <br /> Facility Address: 1711 E Yosemite Ave, Manteca CERS ID: 10422475 <br /> 1 certify under penalty of law that. <br /> 1, t have corrected the violations specified in the Inspection Report from the above-mentioned inspection date, <br /> 2. 1 have peraonally exarnined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the informatlon to be true,accurate,and complete; <br /> Photoa Paperwork,_Statement <br /> 3, 1 am authorized to Submit this certification on behalf of the Respondent. <br /> 4. t am aware that there are significant penalties for submitting false Information,including the possibility of a fine <br /> 8rrd/or imprisonment for known violations. (HSG 2 7191) <br /> Name: K U LtaU-EP SK W,MN Title: <br /> Signature. , � •, Date: I -- <br />