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011 San Joaquin County • RECEIVE® <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 APR 13 2015 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigoy.org/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />ENVIP RMMESERVICEEASL7H <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />recipt of this inspction. <br />thetop of thus forme <br />ewithin 301dayscertification <br />of receipt of the Inspection Report. HSC 25404 Environmental 2(c)(H) Health Department (EHD) address <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 />h failing to comply by the above noted dates will be <br />Note: All EHD staff time associated wit <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/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: March 24, 2015 <br />Inspected By: STACY RIVERA <br />Facility Address: 1817 S FRESNO AVE, 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 />I believe the information to be true, accurate, and complete: <br />Photos Paperwork _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 and <br />imprisonment for known violations. (HSC 25191) <br />Name: ,5 C� ' a <br />Signatu <br />