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RECEIVED <br /> SAN JOAQUIN COUNTY SSP p 9 2014 <br /> ENVIRONWNTAL HEALTH DEPARTMENT <br /> 1868 East Hazefton Avenue, Stockton, Califomia 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web;www.sigov.org/eho ENVIRONMENTAL.HEALTH <br /> PERMIT/SERVICES <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply' in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 30 days of receipt of the <br /> 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 <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the 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 t0 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 resultsimanifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date:August 12, 2014 lnspected By:Elena Manzo <br /> Facility Address:1553 Colony Drive, Ripon EPA L <br /> I certify under penalty of law that: <br /> 1_ I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. l have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the informati to be true, accu , 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 <br /> possibility of <br /> of a fine and/or imprisonment for known violations_ (HSC 25191) <br /> Name: t J )�- 1 "\ Title: <br /> Signatu tcv I JCC j Date- Cl ' ,S <br /> EHO 22.02,01)5 Rav 04/18/12 <br />