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San Joaquin County (iEGEIVEF <br />Environmental Health Department <br />1868 Fast Hazelton Avenue, Stockton, California 95205-6232 APR 1 <br />Telephone; (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.or9/ehd 3 2015 <br />RETURN TO COMPLIANCE CERTIFICATION ANVIRONMENTAL, <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 <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 gther violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EHD within. 3Qdys 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/manifesWtraining records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: March 25, 2015 Inspected By: ELENA MANZO <br />Facility Address: 1553 COLONY RD, RIPON EPA ID: <br />I certify under penalty of law that, <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 proofof compliance FOR t ACH V1O TION <br />I believe the information to be true, urate, and cam e: <br />Photos Paperwork VZStatement <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 />D �' e;{ Ccs j t Eno) ct����r <br />Name: -� S t= i ��- Title:VL° <br />Signature: " ��� Date_ n <br />co <br />v <br />