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'� i <br /> San Joaquin County `°`'. ' C <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 MAR 17 20116 <br /> !� Telephone (209)468-3420 Fax:(209)4683433 Web:www.sigov.oM/ehd <br /> NVIRONMENTAL <br /> RETURN TO COMPLIANCE CERTIFICATION .7_A,Tr,n�pArnerr.iT <br /> Any MINOR violations noted in the "Notice to Comply'in the attached Inspection Report must be corrected within 30 dayj of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EH D)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 3,Q days unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Nate: 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/manifests4raining records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection bate: . �-:ebruar,7 02, 2016 Inspected By: STAGY 1?IVERA <br /> Facility Address: 3730 E MUNFORD AVE STOCK.TON EISA ID: <br /> I certlfiy under penatty of law that: <br /> F 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date- <br /> 2. I 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. t am authorized to submit this certification ars bahalf of the Respondent. <br /> 4. lam aware that there are significant penalties for submitting false information,including the possibility of a fine andf <br /> imprisonment for known violations. (HSC 25191) <br /> Name: e Title: QLut&r <br /> Signature: - <br /> t02 -NSC 25�, 70.1-1. 5 a 0 7A QN B <br /> 2., <br /> lob ,%'F <br /> 7) 3 SFR <br /> 2 <br /> 727 - <br />