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San Joaquin County HEGEIVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton,California 95205-6232 <br /> Telephone:(209)488-3420 Fair.(209)468-3433 Web:www_sigov_oru/ehd MAR 0 3 2016y� <br /> RETURN TO COMPLIANCE CERTIFICAT,Or1 NVIRONMENTAL <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 fop 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 Nailing 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 fbr each violation <br /> Copies of sample results/manifestsAraining recordslother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: ebruary 02. 2016 Inspected By: STACY RNERA <br /> Facility Address: 3730 E MUNFORD AVE, STOCKTON EPA ID: <br /> I certify under penalty of law that. <br /> 1- I 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 /> I believe the information to be true,accurate,and complete: <br /> Photos Y Paperwork Statement <br /> 3. 1 am authorized to submit this cert' ration an 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 /> imprisonnnme``ntfor known violations. (HSC 25191) <br /> Name: ltol iPC` Covrre�& Titie, 0u t&r r4�- <br /> Signature. Date: 3-3 1 b <br /> 2. t!tII � 1 <br /> Q, , 5 44� �o ra�5 aN 5'i <br /> /d —r75C ;Z5.:2,,70' <br /> Z5 4 ?'a <br /> 05 -CFg 112, 7 -1,% )0 ) 'aawe <br /> o� C-F <br /> rf epA 112,7 <br /> 112,7 !e) <br /> -- 1 f Ave2, Cx)t'9 ��iv <br /> 716 Y C'> /� 11•�,S td�Ci�1 Awe <br /> 72�' <br />