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2016-02-26 14:11 FUEL DELIVERY 12092347295 > 2094683433 P 5/6 <br /> San Joaquin County <br /> �b 24f zll� Environmental Health Department <br /> ? 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www,5igov org/ehd FEB 2 6 2016 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIHONd1iiE,NTAL <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 tlAyk 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 Slays 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 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/manifesWtraining recordslother appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: January 25, 2016 Inspected By: STACY RIVERA <br /> Facility Address: 816 E FRONTAGE RD, RIPON EPA ID: Ct�LcnO ZSGS�3to <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. I 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: fff <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 <br /> and/or imprisonment for known violation . (HSC 25191) {{�� <br /> Name < Title: <br /> Signatur Date; Z" ` I L::� <br />