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JAN 2 8 2015 San Joaquin County HECEIVEF <br />Environmental Health Department FEB 12 2015 <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (200) 468-3420 Fax: (209) 468-3433 Web: WMM.2j0d <br />'::NV1R0NMENTk <br />RETURN TO COMPLIANCE CERWICATION <br />Any MINDF3 violations noted in ttie "Notice to Comply' in the attached Inspection Report must be coagct9d within 3 of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (I HD) address <br />at the top of this form within 30 days of reoelpt of the Inspection Report HSC 25404.1.2(c)(1) <br />All correctlan5 tri =p y1glatigns noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to to submitted using this cedirication and retumed to EHD WikWn_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 />Far this certification to be complete, the operator of the site must include: <br />A statement documenting what correcl9ve actions were taken or will be taken for each violation <br />Copies of sample results/rnanifestsrtraining recordslother appropriate paperwork, and/or photos verifying <br />corrections <br />Inspection Date: Janua 27, 2015 Inspected By: ELENA MANZO <br />Facility Address: 1442 Colony Dr, RIPON EPA ID: <br />I certify under penalty of lave 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 Bellowing documentation submitted as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and completes <br />Photos Paperwork V Statement <br />3. 1 am authortzO to submit this certification on behabf of the Respondent <br />4, lam awa that there are significant pene6ties for submitting false information, including the possibility of a fine <br />and/or Imprisonment forawn violations. (HSC 25191) <br />Name: "fit l; P __. �� Title:\) Sfi- PLras� dor���N� rs� <br />