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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 RECEIVEr <br />Telephone., (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.oCgLELhd JAN 3 0 2015 <br />RETURN TO COMPLIANCE CERTIFICAT19NYVIRONMENTAj <br />'1_1?7L11 <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corr ct��'W"IffiMs&ilimbIr <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />at 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 (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EHD within 30 days, unless otherwise specified in the <br />Inspection Report. HSC 26185(c)(3) <br />�4-yff ' i ; <br />Ir V IT " <br />e—assVTrate'07Mn2iYM—,,& 77MIT717 Mt 70-t7w76 r*771,77, 11.57711 <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 \A(Ill be taken for each violation <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Inspection Date: December 30, 2014 Inspected By: ELENA MANZ* <br />Facility Address: 1330 E YOSEMITE AVE, MANTECA EPA ID: CAL 00 0 _�-3 P�7 (Z <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. [have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />and I believe 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 possibility of a fine <br />and/or imprisgriment for known ations. (HSC 25191) <br />Name: Title: <br />Signature: <br />Date: <br />T -d 2691-929-602 jnH uZAaA ejS:G0 91 06 uer <br />