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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton,Califomia95205-8232 <br /> Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.sigoy.orq/ehd <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 forth 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 EHDwithin 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 results/manifests/training records/other appropriate paperwork, and/or photos verifying correctlow <br /> Inspection Date: April 12, 2016 Inspected By: A,yRtItS VELOSc1O <br /> Facility Address: 14000 [ HWY 88 , Lockeford EPA ID <br /> 1 certify under penalty of law that: <br /> 1. 1 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 /> - — I-bellevethe-informalionto-betrue;accurate,-and-ccoomplete � — -- <br /> Photos ✓ Paperwork V 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 forsubmitting false information, including the possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: -De 5 i ;�-- U R Ns Title: <br /> Signature: Date: <br /> 6 <br /> APR 2 2 2016 <br />