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San Joaquin County <br />Ile b <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />AUG 1 <br />Telephone. (209) 468-3420 Fax; (209) 4683433 Web., www.siaov.org/­ehd <br />NX <br />RETURN TO COMPLIANCE CERTIFICATION <br />Ml"- �Any- I R vi*116ns noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 dW—s of <br />�4,recei of t1iis inspection. This certification form must be submitted to the Environmental Health Department (EHD) address; <br />-0 of this 'oim Within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All ctionsftJ other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />25185(c)(3) <br />1W., 19111 � I FIN 11TI/ I W11, 0721 i F"o M <br />\-O,�VuIA ryWl I �ea r*�- ayl, Lj 1 <br />'14 <br />As <br />jftl leco)ZAC, <br />RI <br />Ow Cu V1 lei 1,111, V� W, I ) <br />HD staff time associated with failing to comply by the above noted dates will be <br />I <br />lei <br />1, <br />afthe current hourly rate. <br />riVj <br />, i i <br />fw:ft <br />thuVe <br />rtification to be complete, the operator of the site must include: <br />Ak <br />t io <br />prit documeI. nting what corrective actions were taken or will be taken for each violation <br />psample <br />results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />:10 <br />July 20, 2016 Inspected By: VICKJ IMCCARTNEY <br />FI <br />l� <br />c <br />4219EMORADA LN, STOCKTON EPA ID, <br />Pei <br />uri <br />rlplty of law that: <br />4(9 <br />FITected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />le sonally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />e <br />111 <br />15%� <br />the information to be true, accurate, and complete., <br />is <br />Photos Paperwork _Statement <br />I <br />Ocftbdzed <br />to submit this certification on behalf of the Respondent <br />to that there are significant penalties for submitting false information, including the possibility of a fine and/ <br />00$hrt <br />ent for known violations. (HSC 25191) <br />1W., 19111 � I FIN 11TI/ I W11, 0721 i F"o M <br />\-O,�VuIA ryWl I �ea r*�- ayl, Lj 1 <br />'14 <br />As <br />jftl leco)ZAC, <br />RI <br />Ow Cu V1 lei 1,111, V� W, I ) <br />