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R <br /> SAN JOAQUIN COUNTY RECEIVE[. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazefton Avenue, Stockton, California 95205.6232 �r 07 4�J11 <br /> Telephone:(208)468-3420 Fax:(208)468-3433 Web:www.S ov-or lehd <br /> ENVIRONMENTAL <br /> W EAiTu nrnnoWENT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department (EH D) address at the top of this form within 30 days of receipt of the <br /> Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(I R) or Continuation Folm, 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. HSC 25185(c)(3) <br /> Note: All EHD 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 include: <br /> • A statement documenting what corrective actions were taken or 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: February 24, 2014 Inspected sy:Stacy Rivera <br /> Facility Address:2615 W. Grant Line Rd. EPA ID#: CAL000319459 <br /> I certify under penalty of law that <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 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 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> (M6Name- r'1 u a A N � 6 Pik) Title: p� <br /> Signature: Date: p <br /> SZ <br /> c e n-� I (Zecr��c9 b`( 'n^,x�L `'t <br /> 4!1t'� 19b9a °R'35 oc4y S I� <br /> EHD 22-02-006 Rev 00112 J <br /> S-ta� s•,.-a- <br />