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0 0 ' <br />\m ` <br />. San Joaquin County <br />Environmental Health Department <br />18G8East Hazelton /4venua' Stockton, California 95205-6232 <br />(\ 7e/em6owm,(2OA)4G8-342OFaK:(2OQ)4G8-3433Web: <br />u <br />\/ `~����ETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report mustbe corrected within 30 days of <br />receipt ofthis 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 (|F)orContinuation Form, ordisputes toany <br />violations, are hobesubmitted using this certification and returned hrEHOwithin_3Udays unless otherwise opauifiedinMhe <br />Inspection Report. HSC 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 ofthe site must include: <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: July 01, 2015 Inspected By: CINDY VO <br />K014""41 Us a A <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. 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 I`� Statement <br />3. |amauthorized tosubmit this certification onbehalf of the Respondent. <br />4. 1 a aware that there are significant penalties for submitting false information, including the possibility ofefine <br />imprisonment for known violations. (HSC 25191) <br />-7_-:�,o_~/t�- <br />