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San Joaquin County + <br /> Environmental Health Department _ � N311IWH3d <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 " 1b1N3WNOtiI/1N3 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web:www.sigov.org/ehd <br /> aOZ j 0 ,CdW <br /> RETURN TO COMPLIANCE CERTIFICATION 13AI3038 <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 resultstmanifeststtraining records/other appropriate paperwork, and/or photos verifying correction! <br /> Inspection Date: April0 Inspected By: <br /> Facility Address: ?610 S AIRPORT WAY STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. I 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 VIOLATIOIS <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 /> imprisonment for known violations. (HSC 25191) <br /> Name: CACle SOL(Y16(V1G Title: (-IL) rV)C n 12.P50UrCP c MG <br /> Signature: Date: 4 2 . ( gi <br />