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E <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:www gjgay.ofg/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQR violations noted in the'Notice to Comply"in the attached Inspection Report must be corrected Within 30 dans of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> the top of this foram within 30 days of receipt of the Inspection Report. HSC 25404.1.2(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 using this certification and returned to EHD within 30 days 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 results/manifests/training recordstother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: April 20, 2015 Inspected By: ARIS VELOSO <br /> Facility Address: 2512 E WATERLOO RD, STOCKTON EPA ID: <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,accurate,and complete: <br /> Photos 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 possibility of a fine and/ <br /> imprisonment for known violations. (NSC 25191) <br /> Name: z,nom, Title: / S <br /> r — <br /> Signature: Date: - �� � <br />