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i <br /> i <br /> �(tInj I 2-0 lr� San Joaquin County <br /> i Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-62.32 <br /> Telephotm: (2.09)468-3420 r-ax:(209)468-3433 Web:www.si oLv.org/ehd <br /> RETURN TO COMPLIANCE= CERTIFICATION <br /> ION <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 sublllitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other 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 30 days 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/manifests/training records/other appropriate papeNvork, and/or photos verifying <br /> corrections <br /> Inspection Date: JanWuy '12, 2016 Inspected By: > InCY I:IV1=1%'A <br /> Facility Address: 1333 E CIG'l I'I I I ST, STOCKTON 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 proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: <br /> Photos_Paperwork _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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Nance: Pffy\0,r✓tz V- N � C V ENS Title: �NVIRVNe-,F-N AC-LD <br /> oPF;2cr-n o N S <br /> Signature: QJ V, Date: F(--r,32(AA-eaY f t ; 20 t <br /> RECEIVED <br /> FEB 1 1 2016 <br /> ENVIRONMENTAL ALTH <br /> DEPATMENT <br />