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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www sjgov_orQ/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any M-LN- RR violations noted in the"Notice to Comply" in the attached Inspection Report must be Corrected within 30 days 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 1.2(c)(1) <br /> All corrections to other violations 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 Akin 30 dava unless otherwise specified in the <br /> 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 verifying <br /> corrections <br /> Inspection Date: February 27. 2015 Inspected By: ARIS VE-LOSO <br /> Facility Address: "2-IG S C.H[-R(.KEE-. LN, LOU EPA ID: <br /> I certify under penalty of law that <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personalty 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 a fine <br /> and/or in p.that <br /> for known violations. (HSC 25191) <br /> Na e: FY _. Title:-( <br /> Signature �'_.- Date o�( /',Z) <br /> AE(;F.1Vt:Lj <br /> MAR 2 7 2015 <br /> ENVIRONMENTAL <br /> O n 7T,�SCR�+- <br />