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ISan Joaquin County <br /> Environmental Health Department <br /> 1 . p <br /> 168 East Hazelton Avenue, Stockton, California 95205-6232 �'' <br /> S; Telephone: (209) 468-3420 Fax:(209) 468-3433 Web:www.sigov.orq/ehd RECEI �/�/�:..L' <br /> RETURN TO COMPLIANCE CERTIFICATION SEP 0 8 2014 <br /> ENVIRONMENTAL H�ALTI, <br /> Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected t�itk ��fdav LS <br /> receipt of this inspection. This cettification form must be submitted to the Environmental Health Department(EHD)address <br /> at 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(IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)i(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current lhourly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting iwhat 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 <br /> corrections <br /> Inspection Date: August 13, 2014 Inspected By: STACY RIVERA <br /> Facility Address: 1901 S iiL DORADO ST, STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violati Dns 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 X Statement <br /> 3. 1 am authorized to submit his certification on behalf of the Respondent. <br /> 4. 1 am aware that there are ignificant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for kn wn violations. (HSC 25191) <br /> Name: Title: <br /> Signature: Date: <br />