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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> TNiphan•r(209)468.1420 F":(209)468-3433 Wth:w ,sjgov.orNehd <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 forth must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this fort within 35 days of receipt of the <br /> Inspection Report. <br /> All actions 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. <br /> Note: All EHD staff time associated with falling to comply by the above noted dates will be billed at <br /> the current hourly rate(S ). <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/nnanifests/tmining records/other appropriate paperwork,and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: �V' Rf I/ Inspected By: Stacy Rivera <br /> Facility Address: 4223 C Za& //yl Vf EPA ID#: CA L 000355 Ub <br /> I certify trader 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. I have personally examined the following documentation,submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate,and complete: <br /> Photos Paperwork Statement <br /> 3. I 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 <br /> yotf a fine and/or imprisonment for known violations. (HSC 2519 1) <br /> Name:__ l Qo— ( (/�iq �jt -� Title: ENT ���t(\j <br /> Signature: Ckvis Y d 1; h Date: 01-24 -la <br /> EHD 22-02-005 Rev 08/10 <br />