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DEC-15-2015 13:59 FROM:STCRE 5� 12094781522 • <br /> 70:18186688151 F.3/3 <br /> , <br /> San Joaquin County <br /> Environmental Health Department <br /> 1888 East Hazelton Avenue, Stockton, California 952056232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Wah:www sicov oro/ehd <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 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address i <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 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 END 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 results/manifest3hraining records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspectlon Date: November- 17, 2015 Inspected By: HAZA SAEED <br /> Facility Address: 1469 E HAMMER LN STOCKTON EPA ID: � r-�C <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 VIOLATION <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: BGG E f/ /'�_� Title: <br /> Signature: 4 ZF Z—— Date: <br /> 1N3W1HHdA(1 H1Td3H <br /> WiN]I NNOHIAN3 <br /> Q3Ai303a <br />