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• San Joaquin County • —Rav, " <br /> �(1E l74 Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232b <br /> LIt Z�t� <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.sigov.org/ehd <br /> )✓IS��av� <br /> RETURN TO COMPLIANCE CERTIFICATION <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 /> at 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 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted ` <br /> billed at the current hourly rate. C �ED <br /> For this certification to be complete, the operator of the site must include: FEB 0 12016 <br /> A statement documenting <br /> corrective actions taken will be taken for each vi NVIROF <br /> Copies of sampleresults/manifests/training recods/otheppropriate paperwork, and/or photoj � TAL HE <br /> ALTF <br /> corrections WcES <br /> Inspection Date: January 22, 2016 Inspected By: CINDY VO <br /> Facility Address: 1325 W FREMONT ST, STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. 1 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 /> and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork r 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 possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: ' ��.�; l� t_ Title: <br /> c" <br /> Signature: ;/ "f-j Ir .t_ Date: 14911 G <br />