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Son Joaquin County <br /> FlIVifaftrmlllui HOR1111 Depcfflrrvnt <br /> ' 881' East Auzepon Av wo, Stbactoh, catlfcr -+u 4"705,IGM <br /> Tploph4Rci: 1209 ; fill 342UFax911jMf1) 46lJ% ;1433IN�fl; .lYMsi'� Wi /,rYdhh9 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Arty MINQ11. v4stitlors rioted In Intl Wofte ' n Comply ' lin flin altacr;.ed Inspeelicvi f2ipurt rTMitit tie cnrr& .ted wlthln 3U dav5 of <br /> f�iPt of this Inst>oction. "?tls ceniticatiun fern: must be $UWl tnd li> the Envirer•m,K:lai Hoaltn Dopanmonr ( EHOI itddrew; <br /> :it the top et it" fat +� vdtt►w 311 days ut fecr_ot of the litst)(:c:rvn Report. Hsc as4p4 . ' ;2(01( t } <br /> All colydrtions la olheherylOtullors noted Ir the attached fuspcct,nn tcprvv tIR) zt CoreJnuatron railll. r* dlspt.,ites to any <br /> violaUnnc, are m be submi red using this c. ,:lficakon and ret ._ mit(I to EHU ir,wim � 3_ U �tig unless olher i9 n sporira"I in the <br /> Itlspection Ropott, HSC 25185(c)(3) <br /> Now All EHD staff time associated with tailing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete , ltsiojelalpl' otlh6 W1 it , 'R . :Ie . <br /> A statemP_:il aucwrontng Whatcortlective acdarjej brT-ne l;duirl rw %%ill (x= t:iken .lor each violation <br /> coplrts of gar• '.Ille rnt'ik4W1murifazmi.relring recardVother eppropriala pop vwork. andtor pFotos verifyfnitj <br /> cartectlotis <br /> Operators rerM16 �tktn <br /> Inspection Date : January 694 2014 Inspected By; Elena Manzo <br /> Facility Address : 1097 Y()SEtv1fTE AVE CER$ ID ; 1U ' 8U48t <br /> I Ecrti!y ,UfhdQrpenaltyOf iaw that- <br /> 1 1 have ,3rrt;tcjo the Vioiatiutls spaded in the InSpcvtiuri Rep ort from the ahrive-imeiiii;intaA iri4poctlarl date . <br /> 2 ! hsVfa perS4.1ftily exarrvred ttts fol4oiviti5 documentatior submitter) as urcof of oompkance FOR EACH VIOLATION <br /> and I btylgue the InlormAltin to be true, WAUrdlo, and complete : <br /> Nlrolos Paprrwixk \rf Stetemet�t <br /> 3• 1 am auBtorized to subm`t Ihls cerbrical'on on Gehay or tho Itespocdertt . <br /> 4 _ ) am avtare that there ate sygdicarri peas for suhmitintg taisu lHumiaLon , irdur1mg itra pns_sihility ut a fine <br /> and?or lntpriRottrtltttit for hYlfYwn vlOiatlen*; i;itSC 25191) <br /> Name CQ <br /> ' �• {9 „' rtla , _ %moi J <br /> Signature : <br />