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• <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue Stockton, California 95205-6232' <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web. ___ _sioov or9lehd # <br />RETU'RN TO COMPLIANCE CERTIFICATION <br />Any Mt OR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected wl .ire <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (E�� <br />the top.; of this form within 30 days of receipt of the Inspection Report. HSC 25404,12(c)(1) <br />All corrections to other violation noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any, <br />violations, are to be submitted su ing this certification and returned to EHD within 30 days unless otherwise specified in <br />Inspection Report. HSC 25185(c)(3) <br />Note All EHD staff time associated with failing to comply by the above noted dates will,; <br />r <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 results/manifests/trainina records/other appropriate paperwork, and/or photos verifying correc <br />nspection Date: Junee '16 Inspected By: ARTS VELON' <br />N :� <br />