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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,CaHor nia 95206232 <br /> Telephone:(209)468-3420 Fax.(209)468-3433 Web:www.sinov.oafthd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply'in the attached inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 30 days of receipt of the <br /> InspectionReport. HSC 2540412(c)(1) <br /> All corrections to othgr violations noted In the attached InspectionReport(IR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the 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 documenfSng what corrective actions were taken or will be taken for each violation <br /> c Copies of sample results/manifestslirainina records?other anoronriate paperwork, andior photos <br /> verifying corrections <br /> {_ • Operators certification <br /> I l <br /> Inspection Date: November 18, 2013 Inspected ey:GarrettSaekus T <br /> I <br /> Facility Address: 1916 E March Lane v EPA 09: CA Loo 0 3( 75Sa <br /> 1 certify under penalty of law that: <br /> 1 i have corrected the violations specified in the inspection RcyOrf from the above-mentioned <br /> inspection date <br /> 2. I have perstA wily examined the following dor;uurerriaiiun submiffed as proof of curnphance FOR <br /> EACH VIOL56TION and 1 believe the infcn.alien to be true. accurate and complete: <br /> Photos ✓ Paperwork Statement <br /> f 3 1 am authorized to submit this certification on behalf of the Respondent. r <br /> 4- 1 am aware that there are sign cant penalties for submitting false information including the <br /> possibility of a fine and/or imprisonment for known violations (HSC 2519?) <br /> I I <br /> Flame: '060 Tifle: YvIG7A I <br /> I <br /> Signature: 0,ed�f�i� Date: <br /> EHD==-005RWO411W,2 RECEIVE® <br /> DEC 17 7013 <br /> E 11pipIVAL <br />