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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202 <br /> Telephone: (209) 468-3420 Fax: (209)468-3433 Web: xN��«_ `­o�_fa� _ic;lscl <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached inspection report must be corrected <br /> within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental <br /> Health Department(EHD)address at the top of this form within 35 days of receipt of the inspection report. <br /> All corrections to other violations 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 within 30 days <br /> unless otherwise specified in the IR. <br /> For this certification t0 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 <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: February 11, 2011 Inspected y: Thuy Tran, <br /> Facility Address: 755 S. Tracy Blvd. Tracy, CA 95376 EPAID#: CAR000124883 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos x Paperwork—X—Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Andrea Vilchis Title: UST Compliance Coordinator <br /> Signature: LLZ, Date: March 11, 2011 <br />