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4L F. - <br /> San Joaquin County <br /> Environmental Health Department L <br /> 1868 East Hazefton Avenue, Stockton, California 95205-6232 <br /> Telephone.,(2.09)466-3420 Fax.,(209)468-3433 Web:,V&w JUN 2 3 2016 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MLU-02 violations noted in the"Notice to Comply" in the attached Inspection Report must becorrected w't i 30 da s of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address i <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 s noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certificaton and returned to EHD within 31duas unless otherwise specified in the <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 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: June 13, 2016 Inspected By: FATINAH ZAREEF <br /> Facility Addr4ss:_3304 W HAMMER L.N_, ST0CKT0N EPA ID: <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 <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 andh <br /> imprisonment for known violations. (HSC 26191) <br /> NAine: MA,,-_r>6W /94- Title: <br /> Signature:_, Date: <br />