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D <br />San.loaquin County RECEn r. <br />Envir Drimental Heafth Deparbnent 12 <br />4 <br />1868 East Hazelb in Avenue, 6tocklon, Calffornla 95206-6232 , 9, 2 0 17 <br />Tokpbmw (209) 0 Fax.- (209) 468-3433 Web. rftWgovgWkhd 1ROINNAIEtNTAL HEALTH <br />RETURN TO COMPLIANCE CERTIFICAT6i DEPARTME-NT <br />I IL <br />CZC4175777 <br />of <br />the Inspection Report. HSC 25404.1.2(cXl) <br />JL ation Frm, or disputs o any <br />,L- q#1 died Inspection Report (IR) or Cooet <br />ntinuc <br />F :jjY -J! on and returned to EHDwfthin 30 dW unless otherwise specified in ft <br />Inspection Report HSC 25185(c)(3) <br />Note: All EHD staff time associated with falling tD comply by the above noted dates will be <br />billed at the current hourly rateJ <br />For this certification to be coMplete, the operator of the site must Include: <br />A statement documenting what «• :a• actions were taken or will be taken for each violation <br />Copies of sample resultstmarilleststtrainiN recordslother appropriate paperwork, and/or photos verng oonwbO <br />inspection Date.- January25,2017 inspected By: VICKI MCCARTNEY I <br />L-- and.. Amm- q794% M TRAr-Y RI Vn TRAr.Y <br />I certify under penalty of law that <br />rMT 'PT, M -To M1, ; F 7 2 5,7 nM Toi y 7 I0=1 OFLP <br />2. 1 have personally examined the follovAng documentation submitted as proof of compliance FOR EACH VIOLA110N <br />and I believe the laWmation tD be true, accurate, and compleW <br />______Photos --,��perwork _�Staternent <br />4- lam aware ftAthere are signt;ant penalfiesfbr submitft false inforrnation, including the possibilillyof a fins an --1 <br />imprisonment for known violations. (HSC 25191) <br />Name: —Tdie: eln04 ce— <br />Signature:_ Date- 3121117 <br />