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Oct 25 2016 11:03AM HP FaxFlag Ci+ Chevron 2093341873 page <br /> Sep 27. p161 i No, 0051 F. 9 <br /> RE E 4; San Joaquin County <br /> Environmental Health Department i? <br /> 0 C T 2 5 2016 1668 E891 Hazelton Avenue,Stockton, COROfni&95205-6232 <br /> Telephone;(209)468-3420 Fax:(209)468-3433 Web:w%rw.siarnr.onjLQLd <br /> ENVIRONMENTAL HEALMTURN TO COMPLIANCE CERTIFICATION <br /> DEPARTMENT <br /> AnyM&gvialatterts noted In the"Notice to Comply'In the attached Inspection Reportmust be corfaclig wilhjn at)days of <br /> rocelpt of this inspection. This certifidatian form must ba submitted to the Environmental Hp-ailh 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 vialatigr�o noted in the attached lnspectien Report(IR)or Continuation Form,or disputes to any <br /> v101`00%,are to be submitted using this certification and returned to EHb within 3U'tlava unless otherwise specified in the <br /> Inspection Report HSC 26185(c)(3) <br /> Note; All EHD staff time associated with failing to comply by the above noted data: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 documeiting what corrective actions were taken or will betaken for each violation <br /> Coples of sample resultsrmanlfests/trainrng recdrds/other appropriate paperwork, andror phctos verifying varrections <br /> Inspection Date; SePtember26, 2016 InePocted By; MICHELLE HENRY <br /> Facility Address; 6421 CAPITOL AVE LODI EPA ID <br /> I certify under penalty of low that: <br /> 1. 1 have corrected the violations spactfied in the Inspection Report from the above-men doned Inspection date. <br /> 2. 1 have personally examined the following documentation submitted 65 proof of compliance FOR EACH VIOLATION <br /> and 1 believe the information to be true, accurate, and complete; <br /> „Photos Paperwork Slatoment <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penaitles for submitting false Information, Including the possibility or a fine <br /> and/or Imprisonment for known'/vl'o`iatlons. (NSC 25191) <br /> m <br /> Nae: Llw04j 1�-- <br /> L5 r)AS�E—!(INI ' Title: <br /> Signature: Date: O/ / p �� <br />