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San Joaquin County <br /> Environmental Health Department LL <br /> 1868 Ea, , Hazelton Avenue, Stockton, California952c_ .,232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.si og v.org/ehd t tw <br /> RETURN N TO COMPLIANCE CERTIFICATION MAY, 2 ® 2016 <br /> -. r , <br /> Y"p�-'Gr�o�1e�1 <br /> , <br /> Any MINOR violations noted in�the"Notice to Comply" in the attached Inspection Report must be corrected within 30 day_s 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. HSC 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 osing this certification and returned to EHDwithin 30 days unless otherwise specified in the <br /> Inspection Report. HSC 251850(3) <br /> Note: All EHD staff ti a associated with failing to comply by the above noted dates will be <br /> billed at the curre t hourly rate. <br /> For this certifications to be complete, the operator of the site must include: <br /> A statement documents g what corrective actions were taken or will be taken for each violation <br /> Copies of sample resul stmanifests/training records/other appropriate paperwork, and/or photos verifying correction: <br /> Inspection Date: Marc/ 22, 201E Inspected By: 1./AFINAH ZAREE_i <br /> Facility Address: 2420 EIGHT MILE RD STOCKTON EPA ID: C: A, I_. oo03E73a3 <br /> I certify under penalty of law th t: <br /> 1. I have corrected the vi ations specified in the Inspection Report from the above-mentioned inspection date. <br /> Everything has been complet d with the exception of the CERS registration. I t will be completed by 5-25-16 <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIO <br /> I believe the information to be true, accurate, and complete: <br /> Photos Paperwork x Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there allre significant penalties for submitting false information, including the possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Narne' Owen Kupfer Tit 19: Facilities Manager <br /> Date: 5-18-16 <br /> Signature: <br />