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-*RECEIVED <br />San Joaquin County <br />Environmental Health Department 13 2017 <br />1868 East Hazelton Avenue, Stockton, California95205-6232 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.siaoy.or eRONMENTAS HEALTH <br />Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must becorrected 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 within30 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 (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EHDwithin 30 days. unless otherwise specified in the <br />Inspection Report. HSC 25`185(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 results/manifests/training records/other appropriate paperwork, and/or photos verifying correction: <br />Inspection Date: July 2{), '201( Inspected By: E1__I'NA MANZO <br />Arlrira4s• ?!411 AVE1 E""('AL(')N EPA ID. <br />J---- -.-, - _ <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection elate. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLA <br />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork 1 Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. [ 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 />Name: `� t `� C^ rc t Title: Opexc" �N'ay" � CA <br />Signature: - Date: <br />.tom <br />o,\e FcAune ��n q x�.( mock w ►� 1 <br />Mof�c G 1-r0%61V <br />