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SAN JOAQWN COUNTY <br />ENVIRONMEkTAL HEALTH I)FEPARTMENT FAXED <br />1868 East Hazellon Avenue, Stockton, California 96205 -6232t - <br />Telephone., (209) 468-3420 FaX-* (209) 488-3433 Web: Aw-�Wsi ov-09h■ ela_!h <br />rn IL <br />RETURN To COMPLIANCE CERTIFICATION jUN 17;2014 <br />Any _miNOR violations noted in the "Notice to Comply" in the attached Inspection R t be <br />to Gted within 30 d of receipt of this inspection. This certification form must ==WWAL HEALTH <br />Environmental Health Department (EHD) address at the top of this form within 30 days Of OWFtftNT <br />inspection Report. HSC 25404.1.2(c)(1) <br />All co kns to other viol noted in the attached inspection Report (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this Certification and returned to EHD MMin 30 -days <br />unless otherwise specified in the inspection. Report. HSC 26186(c)(3) <br />Note: All EHD staff time anociated With failing to comply by the above noted dates will be <br />billed at the current hourly rate.. <br />J-- or this certification to be completethe 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 photo$ <br />verifying corrections <br />• operators certcation <br />Ell Inspection Date: - inspected sy: <br />r -r"\ <br />Facility Address: 1605 S. El Dorado St. EPA [D#: feM" lm-ff <br />, . rv) ey"4-� , - <br />I certify under penalty of law that- <br />0 ve-nWtioned <br />1. 1 have corrected the violations ted in the Inspection RipyLfrom the abo <br />spV d L& -PC 0 <br />inspection date. <br />2. 1 have personaffy examined the following docfi <br />u"ntabon subryfrtted Proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />4. 1 am aware that there are significant penalties for submKing f�alse information, including <br />possibility of a fine andW imprisonment for known violations. (HSC 25191) 1 <br />EHD 22-02-005 Rov DM 9112 <br />