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s <br />San Joaquin County <br />Environmental Heafth Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: wimlIgoy.oro%hd <br />Any violations noted in the "Notice to Comply° in the attached Inspection Report must be ggm=d within 30 days of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at <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 days unless otherwise specified in the <br />Inspection Report HSC 251Wc)(3) <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 vitiation <br />Copies of sample resul#shnanifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: July 27, 2016 Inspected By: ARTS VELOSO <br />Facility Add 121 S SAN JOAQUIN ST, STOCKTON EPA ID: <br />1. 1 have corrected the violations specified in the Inspection Report from the abo ndoned inspection date. <br />2. 1 have personally examined the following documentarion submitted as proof of compliance FOR EACH =LATION <br />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />3. l am authorized to submit this certification on behalf of the Respondent <br />4. 1 am aware that there are significant penalties for submitting Was iMormation, Inching the possibility of a fine <br />and/or Imprisonment for known violations. (HSC 26191) <br />August 23, 2016 <br />After review, I concur with the responses <br />the corrective actions as stated. <br />G 13 2016 <br />_ Via!_. ` L _'_ ' r fir•', <br />�1 <br />pr6vided y Bagley Enterprises Inc'. and <br />VID B. MYERS, MANAGEMENT ANALYST III <br />SAN JOAQUIN COUNTY FLEET SERVICES DIVISION <br />