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San Joaquin County REGEIVEL Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sj90Y.Qra/ehd APR 0 6 2015 <br />RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br />MFA! TH f1FPAPT!IFNT <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 daca o <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 i)„4 other viclatioDs 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 w• 0 da s unless otherwise specified fn the <br />Inspection Report_ MSC 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 recordslother appropriate paperwork, andfor photos verifying corrections <br />Inspection Date: March 25, 2015 Inspected By: ELENA MANZO <br />Facility Address: 1553 COLONY RD RIPON <br />I certify under penalty of law that <br />EPA ID: C A R- A 6 O D-10 10 <br />1. 1 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 proo of compliance FOR EACH VIOLATION <br />I believe the information to be true, accurate, and c=Pa <br />te' <br />Photos rwork 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 ands <br />imprisonment for known violations. (HSC 25181) <br />T2S c- )ic'� CbwA vNuA'Acq <br />Name: � 5 '� .__Title: <br />Signatu <br />�"j \rjIcl� 1()Z <br />Date: Lq -.3 — I <br />