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Nov 18 16 09:04a HARNAM CORPORATION <br />K#1003100140 <br />0 RECRvF=n <br />Sall Joaquin Aft <br />all Va4u Ij VUJILY <br />Environmental Health Department NOV 18 2016 L <br />1868 Fast Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.siQov.o[g/ebO �111P <br />ENVIRONMENTAL HEALTH <br />RETURN TO COMPLIANCE CERTIFICATION DEPARTMENT <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (END) 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 -2Q.dans unless otherwise specified in the <br />Inspection Report. HSC 26186(c)(3) <br />a a I <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 resultsirranifestsitraining records/other appropriate paperwork, andior photos verifying corrections <br />M M 11 =1 1 3-17A M I F.11I to V& IN <br />Facility Address: 2430 JOE POMBO PKVVY, TRACY EPA ID: <br />I certify under penalty of law that: <br />1. I 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 />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork V 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 <br />andfor imprisonment for known violations. (HSC 25191) <br />Name: 111/�A*M-1-68-1117 Title: ftNule <br />Signature:_ -Date: --4 <br />7 <br />pax <br />