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r � r � <br /> San Joaquin County H EG E I V E✓ <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton,California 95205.6232 MAR 0 4 2016 <br /> Telephone:(209)468-3420 Fax:(209)4683433 Web:www.sigov.org/ehd <br /> ;NVIRONMENTAL <br /> RETURN TO COMPLIANCE CERTIFICATION'Cn r4 n=060TW-N!T <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 betaken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: February 23, 2016 Inspected By: GARRETT BACKUS <br /> Facility Address: 18662 N HWY 88 , LOCKEFORD EPA ID: <br /> I 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 fallowing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, a complete: <br /> Photos 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 pe ties for submitting false information, including the possibility of a fine <br /> and/or im nment for kn�l``n violation (HS 5 1) <br /> Name: we Title: <br /> Signature: Date: <br /> I <br /> 100/ 100'd 061£# 6,asdca`J 6990LZL60Z 16:90 9SOZ/LO/£0 <br />