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Oct, 15. 2015 4: 34PN Brannon 7i re No, 1465 P. 2 <br /> San Joaquin County �GHVEL <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 OCT 15 2015 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www,sjgov.ora/ehd <br /> RETURN T'0 COMPLIANCE CERTlFICATIWII�C�NMENTAL. <br /> I1U r1C 180TAACNIT <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected within 3QYS of <br /> receipt of this inspection. Thi' certification form must be submitted to the Environmental Health Department(EHD)address; <br /> the top of this form within 30 ays of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corm ions to other violati ns noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations, are to be submittec using this certification and returned to EHD within 30 day s unless otherwise specified in the <br /> Inspection Report. HSC 251 5(c)(3) <br /> Note: All EHD staff timD associated with failing to comply by the above noted dates will be <br /> billed at the curr nt hourly rate. <br /> For this certificatio 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 corrections <br /> Operator's certification <br /> Au ust 12, 2015 Fatinah Zareef <br /> Inspection Date: 9 Inspected By: <br /> Facility Address: 4905 CLAREMONT EPA ID: �qL,pp0 i q 653 Z <br /> I certify under penalty of law tt at.- <br /> 1. <br /> t: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 t <br /> I believe the information to be true, accurate, and complete: <br /> X 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 andlo <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Title: nau c <br /> -7b 16vor <br />