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FROM FAX NO. 15 2016 12:29Rl P1 <br /> San Joaquin County ,_ <br /> Environmental Health Department .�►L,,,,14 ��. <br /> 868 East Hazelton Avenue, Stockton, Caiifomia95205-6232 <br /> Telephor (209)488-3420 Fax:(209)468-3433 Web:www.sicov_om/ehd JUL 15 2015 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 dans 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. Nsc 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(I R) 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 25155' )(3) <br /> Note: All EHD staff ti a associated with failing to comply by the above noted dates will be <br /> billed at the curre t hourly rate. <br /> For this certification to be Complete, the operator of the site must include: <br /> A statement documenti g what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training recordslother appropriate paperwork, and/or photos verifying correction., <br /> Inspection Date: July 1 , 2016 Inspected By:_FATINAH ZAREEF <br /> I <br /> Facility Address: 515 ELEVENTH ST, TRACY EPA la <br /> I certify under penalty of law tha <br /> 1. 1 have corrected the viol 3tions specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have persona ly exam ned the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe th inform tion to be true, accurate, and complete: <br /> Photos K _Paperwork _Statement <br /> 3. 1 am authoriz to sub it this certification on behalf of the Respondent. <br /> 4. 1 am aware tha there a significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprison ent for nown violations. (HSC 25191) <br /> Name: ��V4 Title: 1774o q�Lf-!^ <br /> Signature: Date: � �� <br />