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Any <br />the top <br />Note: <br />0 0 r, <br />San Joaquin County i <br />Environmental Health Department AUG 16 2016 <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web., www.sjgov.cro/ehd •• ION' <br />RETURN TO COMPLIANCE CERTIFICATION <br />violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />this form within 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br />are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br />Report. HSC 25185(c)(3) <br />All EHD staff time associated with failing to comply by the above noted dates will be <br />at the current hourly rate. <br />For t1jis certification to be complete, the operator of the site must include: <br />statement documenting what corrective actions were taken or will be taken for each violation <br />opies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />Date: July 20, 2016 Inspected By: VICKI MCCARTNEY <br />Address: 4219 E MORADA LN, STOCKTON EPA ID: <br />I certify under penalty of law that: <br />1. 11 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. � 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 X Paperwork X Statement <br />3. i 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 <br />i prisonmentfor known violations. (HSC 25191) <br />Title: Di,A-- <br />