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05-29-'18 18:11 FROM- T-130 P0002/0010 F-933 <br /> San Joaquin County 10 <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stooldon, California 9520&W32 <br /> Telephoft.(209)468-3420 Fbw,-(209)468-3433 WOW wwW.Slaov.0rg/ehd AUG 18 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> %d <br /> Any violations noted in the"Notice to Comply"in the attached Inspection Report must be poed within 30 Jim 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 Qgnrectlowtp other violalionA 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 w' in 3Q dayn 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 no 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/mani%stsiltraining recordslother appropriate paperwork,andfor photos verifying corrections <br /> Inspecton Date., July 25, 2016 Inspected By., VICKI MCCARTNEY <br /> Facility Address: 3300 N WEST LN, STOCKTON EPA 111 <br /> under penaKy of law that <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 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 CL�_Statement <br /> 3. 1 am authorized to submit this caffication on behalf of the Respondent <br /> 4. 1 am aware that there are significant penaltWs for submitting false inform n,including the possibility of a fine andfc <br /> imprisonment for known violations, (HSC 25791) <br /> Name: ')Q_SvV) 7die: Yn <br /> Signature, A\/-� DaW_ 1O <br />