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MAY/08/2015/FRI 08:29 AM CENTRAL BUILDING FAX No. 12099377046 P. 001 <br /> t 10j San Joaquin county <br /> Environmental Health Department RE EIVED <br /> 1 2-016 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Tolaphone. (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd MAY 0 8 2015 <br /> RETURN TO COMPLIANCE CERTIFICAT11014�:-NVIRONMENTAL <br /> Any MI violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected!y'lfhin aQ da OT <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address; <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 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 da}Ls 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. April 14, 2015 Inspected BY: STACY RIVERA <br /> Facility Address: 1465 S LINCOLN-ST, STOCKTON EPA 111. <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_k_'-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 andic <br /> imprisonment for known violations. (HSC 26191) uve: W v P-JF-' s <br /> Name:- S—F rdle:SAEig1rif f,W&36- QF-F--iCjEJe_ <br /> ftnatu _Date- (L=Z <br /> 1* 10 C — d*aNe57 macte- 4-o ftte- 114&ni'�ortn f$i&?7 akw( <br /> Is V�r411 44-&� 1 f 0 CC=:e,5 - Am ep+ed by e4D., <br /> �6* ( 07 — Ar, 'a ccur&�e UST Kont"+t)o 1 41 <br /> 4UbM64+ed +o WS -. Ae-eqA-4 bc FAD . <br /> 109 — -Tke da4t na+eci opera+o�- flral'"I'K �or bevy 44 <br /> Le_&\ pe_ r On 4-/2-9/1S, 'Tke U <br /> I A <br /> es <br /> Pe <br /> c6rd I <br />