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i <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 9520R-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www ov.ar lehd <br /> RETURN TO COMPLIANCE CERTIF ATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report musl be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental He th Department(EHD)address <br /> alt the top of this form within 30 days of receipt of the inspection Report. HSC 25404A,2(c)( <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuatio i Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 dans 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 /> or this certification to be complete, the operator of the site must inclu e: <br /> A statement documenting what corrective actions were taken or will be taken fore each violation <br /> Copies of sample resultslmanifestsltraining records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> - Operator's certification <br /> Nicholas Loehrer <br /> Inspection Date: August 21, 2018 Inspecte By. <br /> Facility Address: <br /> 2420 W GRANT LINE RD CERS ID: 10456027 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-rr 3ntioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of co pliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork atement <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, inifluding the possibility of a fine <br /> and/Vion for known violations. (HSC 25191) nTitle: UName: Date: <br /> Signature: '" 1 <br />