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Jany 27 15 07:59p Lower Sacramento Chevron 18775591994 P.1 <br /> W, 14-1 A-T <br /> San Joaquin County RECEIVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95206-6232N 2 8 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web. %%Msiaov,orgleh' 2015 <br /> fIaONMENTAL <br /> RETURN TO COMPLIANCE CERTI FICA ter"nr__17f.0,"V71NA1r <br /> Any MINOR 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 /> 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(I R)or C)ntinuation Form,or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 3 Ltays unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by th;a 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 far each violation <br /> Copies of sample results/manifeststtraining records/other appropriate pap(:rwcrk, ai idlor photos verifying corrections <br /> Operators certification <br /> Inspection Date: October 16, 2014 Inspectod By- Willy Ng <br /> Facility Address* 8660 LOWER SACRAMENTO RD ESA ID: C/, <br /> \c ae,2,_ 2_�j <br /> 1 certify under penalty of law that <br /> 1. 1 have corrected the violations specified in the Inspection Report from the�bove-me itioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as pro�f of compliance FOR EACH VIOLATION E <br /> I believe the information to be true,accurate, and complete: <br /> Photos I —Paperwork_-Z—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 informa ion, including the possibility of a fine andlo <br /> imprfso ent for known violations. (HSC 25191) <br /> Name: Title: <br />