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05/15/2015 4:29 Phi FAX 2095994265 � Z0006/0021 <br /> i <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 E st Hazefton Avenue, Stockton, Galifomia95205-6232 <br /> Telephone:(2 9)468-3420 Fax:(209)468-3433 Web.www.s' ov.or /eihd <br /> RETURN TO COMPLIANCE CERTIFICATIOiN <br /> S <br /> Any MINOR violations noted in the"No ice to Comply'in the attached Inspection Report must be corrected within 30 days f <br /> receipt of this inspection. This certifi ion form must be submitted to the Environmental Health epartment(EHD)adores . <br /> the top of this form within30 days of re.eipi 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 Fom, or disputes to any <br /> violations, are to be submitted using Ns certification and returned to EHDwithin 30 days unless ptherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) I <br /> Note: All EHD staff time as ociated with failing to comply by the above oted dates will be <br /> billed at the current hou y 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 vilation <br /> Copies of sample resuWmani stsltraining records/other appropriate paperwork, and/orthotos Verifying correctio <br /> I <br /> Inspection Date: -i,; 14, 210,1' Inspected By: ELEi f, vtA Z0 <br /> Facility Address: 1 5012"� Jr3.tC Tf')NE RD R1P0)Ni EPA ID: 0oo*2 541 <br /> I <br /> I <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations pec Pied In the Inspection Report from the above-mention d inspection date. <br /> 2. ] have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION ` <br /> I believe the information to be true,accurate,and complete: <br /> Photos Paperwork Statement <br /> i <br /> 3. 1 am authorized to submit this rtification on behalf of the Respondent. <br /> i <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine an <br /> imprisonment for known violations. (HSC 25191) I� <br /> Name; 9 Title: S r , Eli U , l <br /> Signature: <br /> I <br /> i <br /> IV L1, <br /> i <br /> JUN 17 20i.5 <br /> ENVIRO MENTA' <br /> r.]r e�Ts a 1"f;•-� <br /> I <br /> i <br />