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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www sicov ora/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any miNog 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 resultsimanifeststtraining records/other appropriate paperwork, and/or photos verifying corrections <br />Inspection Date: March 13, 2015 Inspected By: ELENA MANZO <br />Facility Address: 500 E LOUISE AVEL. LATHROP EPA ID, CAC002809178 <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 />XX photos XX Paperwork XX Statement <br />3. 1 am authorized to submit this certification an behalf of the Respondent. <br />4, lam aware that there are significant for submitting false information, including the possibility of a fine <br />imospnmp�t for known viola8ons. (HSC 25191) <br />t JcN President <br />Name: Dana �ar Ttie: <br />4�' 20 April 2015 <br />APR 2 2 2015 <br />`,►�VIRONMENTA� <br />•rn• . <br />