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APR-26-2013 14:21 FROM:TRACYT# qP <br /> STOP 12098325307 P'1/2 <br /> ~ <br /> SAN JOAOUIN COUNTY ENVIRONMENTAL HEALTH DEPARTIVISNT RECEIVED 1868 Cast Hazelton Avenue, Stockton,California 95206-6232 Telephone:(209)468-3420 Fax:(209)488-343S Wah:www.siggLv.org/eh APR 2 6 2013 ENVIRONMENTAL RETURN TO COMPLIANCE CERTIFICATIONHEALTH DEP4RTMENT Ant MINQ13 violations noted in the"Notice to Comply� in the attached Inspection Report must be co ected&ahftjQgM of receipt of this inspection. This certification form must be submitted to the EnFironmental Health Department(EHO)address at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1)All Lorroctions to other viglations noted in the attached Inspection Report(IR)or Continuation Form, or die Dutes to any violations, are to be submitted using this certification and returned to r=HD Lyithin 30 days u6 ass otherwise specified in the Inspection Report. HSC25185(c)(3)NC to: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate.F6r this certification to be completethe operator of the site must include;A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections Operator's certification Inspection Date: Ct6q 12.0 Inspected By: eAAA I certify under penalty of law that:1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date.2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, amurste, and complete;Photos Paperwork—��—Statemsnt 2-p"*.j 3, 1 am authorized to submit this certification on behalf of the Respondent.4 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or Imprisonment for known violations. (HSC 25191)Name: Title:Le EHO 22-02-006 Rov 04/19t12 <br />