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SAN JOAQUIN COUNTY RECEIVED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> w_ 60v.2E9 0 7 <br /> Telephone:(209)468-3420 Fax.,(20 -3433 Web. ww.A <br /> 9)468 <br /> EW <br /> ,H D 11M�E'N T <br /> HEAL <br /> RETURN TO COMPLIANCE CERTIF!C�ATION <br /> Any MI violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected withLin_aQj0_W-S of receipt of this inspection. This certification form must be submitted to the i <br /> Environmental Health Department(EHD)address at the top of this form within 30 days of receipt of th4, <br /> 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! <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report HSC 25185(c)(3) <br /> Note: All EMD 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 resultsimanifesW/training recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> * Operators certification <br /> Inspection Date: 7/23/2013 Inspected By:Aris,Caca it <br /> Facility Address:601 E Kettleman Ln EPA ID#: CAL 000183614 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2, 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos_Paperwork--y—L—Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: -16Z� <br /> _7 0 A/ Title: <br /> Signature: !rzZz�—� Date: <br /> EHO 22-02405 Rev 04110112 <br /> z000/z000 In duo;) XSX ST909CCOOZ YVzl NVSV:OT CTOZ/LO/90 <br />