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2017-03-01 09:31 TRACY TRUCK STOP 12098322312 >> 2094683433 P 3/5 <br /> San Joaquin county5� <br /> Environmental Health Departmont <br /> 1866 East Hnzefton Avenue,Stockton, California 95205.6232 <br /> Tolophono;(209)468.3420 Fax:(2D9)468.3433 Web:wwwsfnov.ord/and •�`•'� U 1 201 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"In the attached Inspection Report most be conocted with'n 30 dws o1 <br /> receipt of this Inspection, This certification form must be submitted to the Environmental Hoalth Department(EHD)address at <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404,1.2(c)(1) <br /> All corrections t0 Other vtolatlont noted In the attached Inspection Report(1R)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 spocilled 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 results/manifestsltrsining rocords/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: February 21. 2017 Inspected By: GARRETT BACKUS <br /> Facility Address: 3775 N TRACY BLVD, TRACY EPA ID: _C,_lq L r��o l (�7 Cn(„t <br /> I certify under penalty of law that: <br /> 1. I havo corrected the violations specified in the Inspoctlon 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 believe the information to be true,accurate,and complete: r/11 <br /> Photos '/ Paperwork ✓ StatementQ-q„ti —oX <br /> Ail r o t&_k. c„s:; C- a-4-0..o.CesQ (P^ S(4ne <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. 50k we cu , _ -1c iv-e <br /> 4. 1 am aware that there are significant penalties for submilling false information,including the possibility of a fine <br /> and/or imprisonmont for known violations. (HSC 25191) <br /> Name:J�nJ v N Title: 0 ia r.-or n <br /> Signature nr l v �•Q- n¢ Date:__ L28 )20I'7 <br />