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u <br /> n(�'��'S� San Joaquin County • 0 [�E <br /> SO&gTy7 �?67 �'� Environmental Health Department <br /> RECEIVED <br /> CEIVED <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.so oorg/ehd AUG 2 4 2015 <br /> RETURN TO COMPLIANCE CERTIFICATION EWRONMENTAL HEALTH <br /> PERMIT/SERVICES <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 /> 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 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: august 04, 2015 Inspected By: STACY RIVERA <br /> Facility Address: 2985 LOOMIS RD, STOCKTON EPA ID: ")4-tCOC'-_33"7&172 <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 X 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 impris nrpent for known violations. (HSC 25191) <br /> (I 1, i, V1 C � �, v� <br /> Name: T�� U �1 Title: � �� � �� <br /> Signature: C- Date: 41 <br />