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San Joaquin County RECEIVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California95205-6232 MAR 0 2 2016 <br /> Telephone. (209) 468- 3420 Fax: (209) 468- 3433 Web: www . sogov. org/ehd <br /> ENVIRONMENTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATIONpERMIT/SERVICES <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(EHD) 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 EHDwithin 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185 (c) (3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <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 violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying correction : <br /> Inspection Date : ehruary 03 , 2016 Inspected By : 17I _ ENA MANZO <br /> Facility Address. 321 SPRECKF_ US AVE . MANTECA EPA ID: <br /> I certify under penalty of law that: <br /> 1 . 1 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 /> I believe the information to be true , accurate , and complete : <br /> .Photos / Paperwork 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 and/ <br /> imprison ent for known violations . (HSC 25191 ) <br /> 06 <br /> Name : L(,11 Title : <br /> Signature : 100, Date: �'� <br />