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Mar. 17. 2016 9:45AM No. 2026 P. 1 � <br /> San Joaquin County �' + E- /EIV D P <br /> Environmental Health Department 1,,,� <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org(ehd MAR 17 2016 <br /> RETURN TO COMPLIANCE CERTIFICATION4UNMENTAL <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 des of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address; <br /> the top of[his 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 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/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: Februwy 05, 2016 Inspected By: FATINAH ZAREEF <br /> Facility Address: 3008 E HAMMER LN, STOCKTON EPA ID: CAL aZ>a (INS I�� <br /> 1 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. 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 /> pr P A k- <br /> o�y71JPhotos Paperwork ✓Statement (r <br /> l,( <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: Iy � i t ( (� Title: <br /> Signature' Date: <br /> r a s rpt f 1 11 �? a r r-.F--- <br /> P � <br />