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Jun. 11. 2014 10:41AM No. 7469 K 2 <br /> San Joaquin County <br /> jut 'r, r ao ( Environmental Health Department CEIVED <br /> •l"` 1868 East Hazelton Avenue, Stockton, California 95205-623RE '"w <br /> Telephone.(209)468-3420,Fax:(209)468-3433 Wob.www.8.j99M.orWgW <br /> JUN 112014 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> ENVIRONMENTAL HEALTH <br /> Any tNO violations noted in the"Notice to Comply'in the attached Inspection Report must be p RnAfflWays of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 34 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> Ail enrre-Q Ions to other violations noted in the attached inspection Report(IR)or Continuation Form,or disputes to any <br /> violaations, are to be submitted using this certification and returned to EHD within unless otherwise specified in the <br /> Inspection Report. HSC 26185(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/manifestsitfaining records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Inspection Date: June 05, 2014 Inspected By: STACY RIVERA <br /> Facility Address: 1427 S AIRPORT WAY, STOCKTON EPA ID. CAL000284823 <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 belleve the Information to be true,accurate, and complete: <br /> Photos ^Paperwork <br /> ;Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. lam aware that there are significant penalties for submitting false Information, including the possibility of a fine <br /> and/or imprisonment far known vi ns. (HSC 25191) <br /> Name: i w ��J.4- Title: ? <br /> Signature: Date: r//`� <br />