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06/23/2017 15:20 FAX 209 334 5022 FTG CONSTRUCTION Z001 <br /> SAN JOAQUIN COUNTY JUN 2 9 ` <br /> ENVIRONMENTAL HEALTH DEPARTmEi,r 3, 2011 <br /> 600 East Main Strcct,Stockton,CA 95202-31)29 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:ww',w.sigov.orQ/eft IN <br /> RETURN TO COMPLIANCE CERT UnCATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection]keport must be <br /> corrected within 30 dams of receipt of this inspection_ This certification forth must be submitted to the <br /> Environmerital Health Department(EHD)address at the top of this forri within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Reps art(IR)or Continuation Form,or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report_ <br /> Note: All EHD staff time associated with failing to comply by the above noted elates will be billed at <br /> the current hourly rate($122). <br /> For this certification t0 be complete the operator of th<;site must include: <br /> • A statement documenting what corrective actions were taken of will be taken for each violation <br /> • Copies of sample results/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: (-`®/ :Z�>/I / Inspected By: Stacy Rivera <br /> Facility Address: ai• Aog,6%�� S r EPA ID#: (-,41 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Repo-t from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof'of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate, and complete: <br /> Photos Paperwork_ L Statement <br /> 3. 1 am authorized to submit this certification on behalf of the ResF)ondent. <br /> 4. 1.am aware that there are significant penalties for submitting false information,including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 2519 1) <br /> Name:Signature: Date:Date: I <br /> EHD 22-02-00 Rev 08/10 <br />