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NOV-12-201515:51 From: To:12094583433 Page:2/8 <br /> can Joaquin County EULI �/E <br /> Environmental Health Department ���+++ VV <br /> 1868 East Hazelton Avenue, Stockton, Califomia95205-6232 NOV 12 2015 <br /> Telephone:(209)468-3420 Fax.(208)468-3433 Web.www.sjgaov.orc/ehd. <br /> RETURN TO COMPLIANCE CERTIFICATI VIRONMENTAL <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must becorrected within 30 days of <br /> receipt of this inspection_ This certification form must be submitted to the Environmental Health Department(EHO)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 othor 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 25155(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 resultslmanifeststtraining records(other appropriate paperwork, and/or photos verifying correction; <br /> Inspection Date: _ Oclober 13, 2015 Inspected By: ELENA ivANZO <br /> Facility Address: 255 MOFFA i tiLVD, MANTECA EPA ID: CAG tom? 229 - <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Deport from the above-mentioned inspection date_ <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> believe the information to he true, accurate,and complete: <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 for submitting false information, including the possibility of a fine and/ <br /> imprisonmentforknown violations. (MSC 25191) <br /> �� <br /> Mame: r"! ti Title- <br /> Signature: pate: r <br />