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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, Californiawww.sj62 Gr 1V�L <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s ov.o {I!s <br /> RETURN TO COMPLIANCE CERTIFICATION APR g 0 20 <br /> CCt^^O''TTTT <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must Wf <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health DMMXZ 5E( � ress; <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(I R) 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 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/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: March 18, 2015 Inspected By: ELENA MANZO <br /> Facility Address: 1022 E FRONTAGE RD, RIPON EPA ID: <br /> 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: &j2) tam Title: Cep <br /> Signature: c Date: sir I i <br /> l °J �- C.. Q Q '4 =t l` 2 c��owe a ?'4'-_C� 9 <br /> � �nv„�'^•`-C" l�(�"� Se 9--��*', � �s-� u vow. �I..1a,�..1'�C�, <br />