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San Joaquin County <br /> Environmental Health Department <br /> 1660 East Hazelton Avenue,Stockton, California 95205.6232 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.sraov.orclehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in Ihe'Notice to Comply'in the attached Inspection Report must be r4rrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHO)address , <br /> the lop of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All.r 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 dava 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 cr will be taken for each violation <br /> Copies of sample results/menifestsitraining recordslother appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: March 02, 2016 Inspected By: STACY RIVERA <br /> Facility Address: 1240 NAVY DR STOCKTON EPA IDid`h�g73"72a5 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the aboveanentloned Inspection date. <br /> r_ 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION i <br /> r—J <br /> believe the information to be true, accurate, and complete: <br /> nPhotos—Paperwork <br /> f 3. 1 am authorized to submit this certification on behalf of the Res <br /> Zia <br /> pondent <br /> I <br /> ro4. 1 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) 1� <br /> m ! Name: =E..F:P Title:__ !1X51 rtS �r P�I'1 dylq C►� "R <br /> Signature: k� Date: -3 c) /.;?—o f b <br />