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RECEIVED <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT JUL 2 12014 <br /> 1868 East Hazelton Avenue,Stockton, California 96206-6232 <br /> Telephone:(209)4M3420 Fax:(209)466-3433 Web:w—ww.sj!jov.o IRONMENTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply"In the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report- HSC 25404.1.2(cX1) <br /> All orrections to other violations noted in the attached Inspection Report(IR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. HSC 25185(c)(3) <br /> Note: All END 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/manifeste/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date. 7/16/2014 Inspected By:Thuy Tran <br /> Facility Address: 147 E. LATHROP RD EPA ID#: CAL000172313 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos--k—Paperwork 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Title: <br /> Signature: r Date: 7`160-1�1- <br /> FHD 22-02-006 Rev 04/1912 <br /> V0/Z0 39Vd SAM SMI 9909989602 6E:ST tTOZ/8T/40 <br />