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San Joaquin County 0 6 2 0117 EnVironmental Health Department 1868 East Hazelton Avenue, Stockton, Califomja95 Telephone: (209) 468-3420 Pax. (209) 468-3433 Web: RETURN TO COMPLIANCE CERTIFICATION Any MINQE violations noted in the "Notice to CompV in the attached Inspection Report must be correctEW 3j5fthin 30 don of receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EH1D) address at the top of this kirm within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) AD coEM=ns to other ylolg-&ns noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations. are to be submitted using this certification and returned to END withil] 30 dM unless otherwise specified in the Inspection Report. H.SG 25185(c)(3) Note- All t. time associated with failing to comply by the above noted dates Will be billed at the current hourly rate. For thiscedification to be complete, the operator of the site must include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training recordslother appropriate paperwork, andfor photos verifying corrections operators certification Inspection Date: September 23, 2013 Inspected By: Elena Manzo Facility Add ress: 2072 W YOSEMITE AVE CERS ID: 10181669 1 certify under penalty of law that: 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: Photos _______Paperwork Statement 3. 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine andlor imprisonment for known violations. (HSC 25191) Name: ?; Title: Signator Date:t 100 ocA-. 7 M46 filf&- 2,01'7 ANP L -d OOLGItZ960Z doqSNoinb doo: Lo I I, go Inr F� San Joaquin County 0 6 2 0117 EnVironmental Health Department 1868 East Hazelton Avenue, Stockton, Califomja95 Telephone: (209) 468-3420 Pax. (209) 468-3433 Web: RETURN TO COMPLIANCE CERTIFICATION Any MINQE violations noted in the "Notice to CompV in the attached Inspection Report must be correctEW 3j5fthin 30 don of receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EH1D) address at the top of this kirm within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) AD coEM=ns to other ylolg-&ns noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations. are to be submitted using this certification and returned to END withil] 30 dM unless otherwise specified in the Inspection Report. H.SG 25185(c)(3) Note- All t. time associated with failing to comply by the above noted dates Will be billed at the current hourly rate. For thiscedification to be complete, the operator of the site must include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training recordslother appropriate paperwork, andfor photos verifying corrections operators certification Inspection Date: September 23, 2013 Inspected By: Elena Manzo Facility Add ress: 2072 W YOSEMITE AVE CERS ID: 10181669 1 certify under penalty of law that: 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: Photos _______Paperwork Statement 3. 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine andlor imprisonment for known violations. (HSC 25191) Name: ?; Title: Signator Date:t 100 ocA-. 7 M46 filf&- 2,01'7 ANP L -d OOLGItZ960Z doqSNoinb doo: Lo I I, go Inr