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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazeltan Avenue,Stockton,California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)466-3433 Web:AWff ggv gaW0dd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MI violations noted in the"Notice to Comply'in the attached Inspection Report must be r�nectStSi-within 30 days of <br /> at the top of this foam within 30 days oftrece pt me Ion form must nspection Report SC to the 125404.12(c)(1)�Department(EHD)address <br /> All roections to other violations noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> m <br /> violations,are to be submitted using this certification and returned to EH❑within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with falling 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 statemant documenting what corrective axions were taken or will be taken for and/or violation <br /> verifying <br /> Copies of sample results/manifests/trainitp 10=rdsldhar appropriate <br /> paperwork. photos <br /> corrections <br /> Inspection Data: October 17, 2014 ,Inspected By: GARRETT BUACKUS <br /> Facility Address: 4501 N Pershing Ave. Stockton EPA ID: GR? �� I I �D� aSs <br /> I certify under penalty of law that- <br /> 1 <br /> hat1. I have corrected the violations specified n ww Inspecfar'Report from the above-mentioned inspection dale. <br /> 2. 1 have personalty examined the following documematlon submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, anowate,and complete' <br /> Phaba X paperwork Statement <br /> 3. lam authorized to submit this certWc~an beh M of the Respondent <br /> 4. lam aware that there are significant penvalnes for submmting false information,including the poeafbirdy of a fine <br /> and/or imprisonment for,kkn I latiorer me 251w) <br /> Name: n (� Trtle: 2e5 ENS. Cu 1`,gn_ Sec, �,s <br /> \'rte � <br /> Signature: 41Lv Date: li 13 Z <br />