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2015-05-04 14:39 TRACYALRUCK STOP 12098322312 2094683M P 1/3 <br /> San Joaquin County N\k ECEIVEL, <br /> Environmental Health Department <br /> 1868 East Hazalton Avenue,Stockton,California 952056232 MAY 0 4 2015 <br /> Telephone:(209)468-U20 fax (209)468-3433 Web, <br /> ENVIRONMENTA, <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any NUNO violations noted in the"Notice to Comply"in the attached Inspection Report must be'gg[mgWd wjjb1ajQdW of <br /> receipt of this 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 26404.1.2(c)(1) <br /> AII!M=igj32 IQ o-thgr_yg1j§2na noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD md1bInXdayA unless otherwise specified in the <br /> Inspection Report. HSC 251 86(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 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/manifests/training records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: April 29. 2015 -Inspected By: MICHELLE HENRY <br /> Facility Address: 3940 N TRACY BLVD, TRACY EPA IM. nm.oo Q 7-Z I is 1 <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 Statement 2 a-57, <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 possibility of a fine and/c <br /> imprisonment for known violations. (HSC 25191) <br /> Name: u K t2 E 6iArL^ Tdle: 0.4 rl?$ �o <br /> ignatu. <br />