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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205--6232 <br /> Talophone:(209)468-3420 Fax:(209)468-3433 Web: '9 <br /> _MMW.§j <br /> WWAQ9_v.or <br /> o_ hd <br /> �_oh <br /> q/e <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MLtLQR violations noted in the'Notice to Comply" in the attached Inspection Report must be co[Lectgd withkQO da 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 otpLyLolatiiQ <br /> violations:noted in the attached Inspection Report.(IR)or Coritinuation Form,or disputes to any <br /> violations,are tobe submitted using this certification and returned to EHD within davk 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 resu Its/man ifests/traln ing records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: February 26, 2016 Inspected By: CINDY VO <br /> Facility Address: 427 N WILSON WAY, STOCKTON 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 personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: , <br /> Photos Paperwork f'.._/Statement <br /> 3. [ 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 andt( <br /> imprisonment for known violations. (HSC 25191) <br /> Name: 4'4'Z,� Title: <br /> Signature: Date: <br />