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T)U� " <br />�~ bi v San Joaquin County <br />��n��� �� '��}J <br />EnvironmentalDepartment <br />[/(�/UK�� .�~// ��= |°[ 1868East Hazelton Avenue, Stockton, California D52U5-6232 <br />Telephone: (2OQ)488'3420Fax: (2OA)488-3433Web: <br />Any MINOR violations noted inthe "Notice toComply" in the attached Inspection <br />receipt ofthis 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 (|F)orContinuation Form, ordisputes hzany <br />violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified inthe <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 />Astatement documenting what corrective actions were taken mwill betaken for each violation <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br />InspectionDate: September 29, 2014 Inspected By: STACY RIVERA <br />Facility Address: 2375 N TRACY BLVD, TRACY EPA ID: L�=,, I <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report frorn 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 X Paperwork Y 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 imprisonment for known violations. (HSC 25191) <br />Signature: k a,101­,—� Date:. ID 12-311H <br />