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s � <br /> -Due (c <br /> San Joaquin County A <br /> Environmental Health Department <br /> t(S-4' I 1.�J - 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 468-3433 Web:www.sjgov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <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 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 paperwork, and/or photos verifying corrections <br /> Inspection Date: July 06, 2015 Inspected By: STACY RIVERA <br /> Facility Address: 4704 FITE CT. 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 complian E fA-tE <br /> I believe the information to be true, accurate, and complete: AA.�,e,, �� . <br /> Photos Paperwork ""; Statement JUL 2 9 <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. ENVIRONM <br /> HF �r ��A�. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the f's"s%i iR dfYfrti4tand/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: l itle: <br /> Signature:___. Date: <br /> L i£M <br /> 301 _ r/16.eS AA✓L c , / All S4"&1 IJeA,.yS <br /> l� � Acs u�r vrs��� �l. l,clsf Ce'.P✓ <br /> auF gyros e 5 pec �GaJ <br /> 4/4 5 S mac.( GoMPZI-11- > AS 0 (- -7 'a3 is <br /> -7/ 3 TA.-,L As5cssn,--/S Wc-w-c. e"'6'c f" oAJ -7 ..20 �o! ! <br />