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San Joaquin County <br />Environmental Health Department 1 <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />relophone: (213 9) 468-3420 Fax: (209) 468-3433 Web-- www-sigov.o H <br />N <br />ENV1,M, <br />\�T <br />RETURN TO COMPLIANCE CERTIFICATIM <br />�Ii- 0 0 1p <br />I a tM-71 ro r -7-7--m rs, - j I I a <br />Inspection Repo,t. HSC 25185(c)(3) <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />Willed at the current hourly rata <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/manifests1training recordstother appropriate papenwork, andlor photos verifying <br />corrections <br />Operator's certiftabon <br />Inspection Date: <br />September 23, 2013 <br />Inspected By: <br />Elena Manzo <br />Facility Address: <br />2072WYOSEMITF-AVE <br />CERS 11): <br />10181669 <br />ITSTI-111IM!'11117- �-171R-7111 r1-MT#-,79;9'T6T-R, Z-3 <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 Staterneu <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 imprisonment for known violations. (HSC 26191) <br />Nam�- Title: 0 Adnl iL- <br />Signaturls'--',' Date._ 6-12 <br />S'd 0019tZ860Z doqS �oinb d Lo: 1,0 L 1, 90 Ind <br />