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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232orc ghd <br /> Telephone:(209)468,3420 fax:(209)468-3433 Web:���_ <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MSR violations Hated in the"Notice to Comply' in the attached Inspection Report must be�;►�actsd w' in 30�ays of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.12(c)(1) <br /> All r&rregUgnc to nshpr vicLlatians noted in the attached Inspection Report(IR)on Continuation Form,or di sites to any the <br /> violations,are to be submitted using this certification and returned to EHDi�-I <br /> specif <br /> Inspection Report_ HSC 251$5(c)(3) <br /> ith failing to comply by the above noted dates will be <br /> Note: All EHD staff time associated w <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 or each violationor verifying <br /> Copies of sample results/manifestsftraining records/other appropriate P p <br /> corrections <br /> Inspection Date: October 13, 2014 Inspected By: ELENA MANZO <br /> Facility Address: 1399 N MAIN ST, Manteca EPA ID: <br /> I certify under penalty of law that: <br /> 1, t have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 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 X Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Despondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the possibifity of a fine <br /> and/or imprisonment for known violations. (MSC 25191) <br /> Name: <br /> Stephen Boyd Title; Rg. Gasoline Env. Com . Mgr. <br /> $1gnatU«: <br /> 4 Date: 11/5/2014 <br /> RvE �: <br /> NOV 0 4 2014 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />