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2014-05-02 10:17 TRACYJUCK STOP 12098322312 2094683433 P 1/1 <br /> SAN JOAQUIN COUNTY <br /> ENV06NMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:XMsigovAll C <br /> EIVED <br /> RA? 0 2 2014 <br /> RETURN TO COMPLIANCE CERTIFICAWOMONMENTAL HEALTH <br /> Any MINO_R violations noted in the"Notice to Comply"in the attached Inspection RepoAffierMENT <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within$0 days of receipt of the <br /> Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to ether 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 /> , <br /> unless otherwise specified in the 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-sate. <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/manifestoAraining records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: Q I 7,C icy Inspected By: j&6Q <br /> Facility Address: T_0zg_-q!d_ C-' ev 2S--So -_ EPA ID#:a­AL-0 <br /> I 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. J>,%s r%o ceeS 10 1041/335 h4414aq e, 4 (*(W(q, <br /> �*)CX440ocj, OCce-p��4 Cpl-j Cdv�Q.,s - , <br /> 2. 1 have personally examine;the'following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I beli6e the information to be true, accurate,and complete: <br /> Photos—Paperwork _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: —Title: <br /> Signature: r,.1,A-j, Date: S 2,0 i' <br /> EHD 22-02-005 FR®v 3111 <br />