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San Joaquin County , <br /> v Environmental Health Department <br /> 1868 East Hazelton Avenue.Stockton, California 95205-6232 <br /> PeR O 10,6 Telephone:(209)468-3420 Faz:(209)468-3433 Web:www sioov.ora/ehd <br /> 1POETURN TO COMPLIANCE CERTIFICATION <br /> UNa� <br /> 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(EMD)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 gther 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/menifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: March 31, 2016 Inspected By: STACY RIVERA <br /> Facility Address: 2525 E MARIPOSA RD, 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. ] 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: Title: ! /OiuQG A�WAC70� <br /> Signature: Date. `0_0_14 <br /> 5�4hv��trntcct���S��yrrLa.4iz.'� l.]rn.�� '��-A--cccyG,��p f►.l !f �{U-� <br /> f?' nA`irf�T'r�G/�r .v�Oft A.-C 1rAtY� NSA . NJr <br /> 4-10-3 U pl>prtV;r> w ►-t t, ,4S-t. l=Vl7_jpA . <br /> d%Zo-2 - AMA& n ra�u r ► t a �>�r AJC <br /> $I t R►-t p ov A"( 4 Aa airs 1.]g5-i L <br />