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San Joaquin County RECEIVEL <br />Environmental Health Department <br />1868 l=ast Hazelton Avenue, Stockton, California 95205-6232 APR U 6 2015 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.or etj <br />RETURN TO'COMPLIANCE CERTIFICATIOI NVIRONMENTAL <br />AFAIT <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 s <br />the top of this form within 30 days of receipt of the Inspection Report. HSG 25404.12(c)(1) <br />All corrections tQ nth!;r violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to to submitted using this certification and returned to EMD within. 3Qdays unless otherwise specified in the <br />Inspection Report_ HSC 25165(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 25, 2015 Inspected By <br />Facility Address: 1553 COLONY RD, RIPON <br />I certify under penalty of law that,. <br />ELENA MANZO <br />1- 1 have corrected the violations speed in the inspection Report from the above-mentioned inspection date_ <br />2. 1 have personally examined the following documentation submi77�Sta <br />oo f compliance FOR EACH VIOLATION <br />I believe the information to be true, urate, and cam e: <br />Photos Paperwork tement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br />imprisonment for known violations. (HSC 25191) _ <br />Name: 7e SS-� DI �� Title:Weli- CUSS �vlJfi'AuhC"` <br />Sig <br />