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San Joaquin County <br /> Environmental Health Department APR 242015 <br /> 1868 East Hazelton Avenue, Stockton,Califomia 952058232 /t <br /> Telephone:(209)468-3420 Fax:(209)468-3433 web:www.sioov.om/and �VIRONMI NTAi <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR 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 resuita/man'rfestsftraining records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: March 25, 2015 Inspected By: STACY RIVERA <br /> Facility Address: 1240 NAVY OR, STOCKTON EPAID. i3'T22ca <br /> I certify under penalty of law that <br /> 1. I 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 /> 1 believe the information to be true,accurate,and complete: <br /> Photos Y Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent <br /> 4. 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) <br /> Name: ,C- 6'2s Tale: ` �s Ur51r c N-11<C <br /> Signature: Date: - 2- - <br />