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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California!95205-6232 <br />rolophone. (209) 468-3420 Far: (209) 468-3433 We,b: Nigov.pral 0 <br />P I V I <br />FRETURN TO COMPLIANCE CERTIFICMidk <br />Any MI violations noted in the "Notice to Comply" in the attached Inspection Report must be c!2rreated yglftn 39 d of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHU) address <br />at the top of this form within 30 days of receipt of the Inspection Report HSC 25404.1.2(e)(I) <br />All mwlpana to othm viol gbons 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 EHID within 30daysunless otherwise specified in the <br />Inspection Report HSC 25185(c)(3) <br />aiaff It -Ila aaaxe�=-t will be <br />billed at the current houdy mte. <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 betaken for each violation <br />Copies of sample resuWmanifestsitraining recordslother appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certification <br />Inspection Date- September 23, 2013 Inspected BY: <br />Facility Address: 2072 W YOSEMITE AVE CERS ID: <br />I cerfify under penalty of law that. <br />Elena Manzo <br />ME= 4 <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 />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. lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. {HSC 25191) <br />2= <br />Oil <br />Title:._ <br />.Dater <br />g'd OOL9VZ964Z do48 Noinb dZo: LO L L 90 jnr <br />