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03-20-'19 14:28 FROM- T-509 P0001/0001 F-987 <br /> San Joaquin County <br /> Environm"l Health Department RE0F\,. :.'.D <br /> 9 868 East Hazelton Avenue on <br /> ,Stockton,Catlforn,a 95205-6232 <br /> Telephone:(209)4W3420 Marx:(209)46&3433 web:www.si9QV_9Mt!5 dJUN (1'��201 l 0 <br /> r--, <br /> RETURN TO COMPLIANCE CERTIFICATION_NVIRONMENTAL HEALTH <br /> Any MINOR violations noted in the-Notice to Comply'in the attached Ins p �Fp:A,TM ENT <br /> Inspection Report must be rreded . 'n 3t)'-()I- 'MP' <br /> receipt of this inspection. This certification tm must be submitted to the Environmental Health Depattrnent(EHD)address at <br /> the top of this form within 34 days of receipt of the Inspection Report. HSC 25404,1.2(c)(1) <br /> Allns other viol 'ons 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 /> lnspwtion Report. FISC 25185(c)(3) <br /> Note: All F-HO 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 inekcide: <br /> A statement documenting what corrective action$were taken or will be#aken for each violation <br /> Copies of sample resutts/manifestsftraining recordslother appropriate paperwork.and/or photos verifying corrections <br /> Inspection Date: May 22, 2017 Inspected By. AARON t-ANIG <br /> Facility Address: 8115 S E? DORADO ST. FRENr'HC""A+nf P EPA ID: <br /> I certify under penalty of law that <br /> r 1. I have oorrected the violations specified in the Inspection Report from the above-mentioned inspection date_ <br /> 2- t have Personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,and 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 penalties for submitting false information,including the possibility of afine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: 1J C4Ttle: V C1 <br /> Signature: E4 Date: 7in <br /> V�o� ris <br /> t D3 C09p­2 C7"-K> t -no ugi. aj �r�cp C5 . <br /> cc) zZ .P.cNe-T_> V\ Cis, <br /> CD"4-e a7eZl 0'-d frJl�" <br /> e'g L-'o a n P <br />