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San Joaquin County <br /> Envirorrnentlaf Heath Department <br /> 1866 East Hazelton Avenue,Shx*h) ,+Cailomia95205-6232 <br /> TeMphoa (209)4BB-3420 For.(209)468-3433 Nb <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> My MINM violabons noted in the' obca to Comply"in the attached Inspection Repeat must be corracted within 30 d=of <br /> receipt of this inspection. This ceriiication form must be submitted to the Environmental HeaM Department(EHD)address a <br /> the lop of this form within 30 days of receipt of the Inspection Report- HSC 25404.12(cXl) <br /> At coonactions bo cbeLviakalm noted in the attached Inspection Report(IR)or Continuation Farm.or disputes kn any <br /> vkA@Nions.are to be submiled using tttis c artifinafion and returned to EHD within 30 days unless otherwise specified in iha <br /> Inspection Report. HSC 251115(c)(3) <br /> Nob: All EHD staff time assodaled with failing to comply by the above noted dates will be <br /> billed at the current hourly raft. <br /> For this Certifimbol'1 to be complete, the operator of the site must incfude: <br /> A statement docameriing vAd corrective actions were taken or w l be taken for each violation <br /> Copies of sample rec crdEYother appropriate paperwork,andnor photos verifying corrections <br /> Inspection Data: June 27,2018 Inspected By: STACY RIVERA <br /> Facility Address: 1777 W YOSEMITE AVE,MANTECA CERS ID: 10181559 <br /> 1 cartiiftr under panalty of law that: <br /> 1. 1 have corrected the viols specified in the Inspection Report from the above-mentioned inspection dale. <br /> 2_ I have personally examined the fotiavring docanpeneation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true,accurate,and complete- <br /> l ® Fapervwork_�Slalament <br /> 3_ 1 am authorized to subndt this cartificiakwn on behalf of the Respondent. <br /> 4_ 1 am aware that tinware are significant penalties for subnu ing fatse information,kxUlling the possiaiity of a fine andf <br /> imprisonment for known viclabons. (HSC 25191) <br /> C lef Ergineer Kaiser Maniacs Midi a C:enw <br /> Name: X10 ernbin Title: <br /> sam.corbin@kp •'w•+ <br /> _mow <br /> SIgnatut'e: 1264111 4r late: 7.271016 <br />