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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 468-3433 Web:www.s*qov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in he"Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This ertification form must be submitted to the Environmental Health Department (EHD) address; <br /> the top of this form within 30 da s of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violation 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)(3) <br /> Note: All EHD staff time ssociated 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 resul /manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: August 12, 2015 Inspected By: Fatinah Zareef <br /> Facility Address: 4905 C AREMONT EPA ID: <br /> certify under penalty of law tha <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally exami ed the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to sub it this certification on behalf of the Respondent. <br /> 4. 1 am aware that there ale significant penalties for submitting false information, including the possibility of a fine and/o <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Title: <br />