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Fax Server 9/5/2014 3 : 44 : 51 PM PAGE 2/008 Fax Server <br /> RECEIVEL) <br /> SEP 05 2014 <br /> SAN JaAQUIN COUNTY ENVIRONMENTAL <br /> ENVIRONMENTAL HEAt_TH DEPARTMENT HEATH nPPAoTAAcA1-- <br /> 1bB&Fast;Hadetton Avenue,Stockton,California 952058232 <br /> Te/ephorrar(249)468-3424 pax:(209)4$&3433 Web:wyyv.�goy.or tg_eh <br /> RETURN TO COMPLIANCE CERTIFICATIO <br /> AnyIM NOR violations noted in the'Notice to Comply"in the attached Inspection Repo, must be <br /> ed within 301M of receipt of this inspection_ This certification form must be s�bmitted to the <br /> correct <br /> Environmental Health Department(FHD)address at the top of this form within 30 day of reoelpt of the <br /> inspection Report. HSG 25404.1.2(c)(1) <br /> ouation Form,or <br /> All rnrrertions to ether��olatipns noted In the attached inspectioePotlurned toHD wiin 30 davx <br /> disputes to any violations,are to be submitted using this certification <br /> unless otherwise specified in the inspection Report, HSC 25183(c)(3) <br /> Note: Ail END staff time associated with failing to comply by th,a above npted 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 resultsimE)nitestsAraintn9 recordslother appropriate paperwork,andlor photos <br /> verifying corrections <br /> • gperator's certification — <br /> AU ust 12, 2014 inspected i3y:Elena anzo <br /> Inspection Date- _� — <br /> Facility Adares:s:1553 Colony Drive, Ripon _ EPA tut#� A �•O �0 <br /> I <br /> I certify,under penalty of law that: <br /> 1_ 1 have corrected the vialatiores spectNPd inthe Inspecfion Report from thea ve-mentioned <br /> inspection date. <br /> 2. t have personalty examined the following documentallarl submitted as proof 1°f compliance FOR <br /> TACH VIOLATION and I believe the info to be tree,,accuu[pw.and complete: <br /> Photos_- <br /> Paperwork_ZS ent <br /> 3. 1 am authorized to submit this oertffication on behalf of the Respondent <br /> atties for submeti false info i,including the <br /> 4. lam aware that there am significant pen r'9 <br /> possibility of a fare and/or impnsonrnent for known violations- (HSC 25 191) <br /> 7191natur : <br /> _ <br /> Elis a-02 Rev W119.'12 <br />