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06/09/2016 11:47 2098585066 TWOGUYS PAGE 01/02 <br /> 0 9 <br /> San Joaquin County <br /> Environmental Health pa ant <br /> 1868East Hazel lon Avenue,Stockton,California 96205-6232 <br /> TaWhaw,-(209)468-3420 Fax.,(209)468-3433 Web.WMAgOLM12tid <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> in the attached Inspection Report must be gorr —n 3 0 of <br /> Any MINOR violations noted In the"Notice to Comply" __ggjd WIftig QAmM <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 parr ons to.g1fiKlUatigns noted in the attached Inspection Report(R)orCoritinuation Form,or disputes to any <br /> violations, are to be submitted using this cerfification and returned to EHD wj29a3j dw unless otherwise specified in the <br /> Inspection Report. HSC 26185(0)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted da te$will be <br /> billed at the current hourly rate. <br /> For this certification to be completa, 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 resufts/manifestattraining recordslother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Data: June 07, 2016 Inspected By: .VICKI MCCARTNEY <br /> Facility Address, 147 E LATHROP RD, LATHROP EPA' 111. <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 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, a=rate,and complete: <br /> Photos_Paperwork 4-1/statement <br /> 3. 1 am authorized to submit this cartiftation on behalf of the Respondent. <br /> 4. 1 am aware Oiat there are significant penalties for submitting false information,including the possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> flame: f Title: <br /> Signature. Date: 1 <br /> JUN 0 9 7016 <br />