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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALT14 CEPARMILN i <br /> 1368 Eas: Hazelton Avenue. Stockton,Caiiforma 9`205-6232 <br /> Telephone:;2C9)468-3420 Fax-'(209)468-3433 Web:wwW-slQov oraJehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Ary M NOR vloi3b-ns noted in t'ne 'Nob;,e to Corr,uiy'in the attached Insfectizm Repot, n-ust be <br /> corrected within 30 dabs of receipt of this inspection. This 3ertdfcation form n;l_st be S-Lbmitte- to the <br /> Environmental Health Department FHD'r address at the top of t^,is form mtNn 3G days of receipt of the <br /> IrspectonReporl. HSC 25404,1.2(c)(1) <br /> A3;,o�,az;Vons to otfier violations noted ;r,'he afachec' inspection Rapart(IR) c.Continuation Fora,, or <br /> d!sputes to any violations, are 17 be subr nitted Using this certification, ant Ietjrr�ta to EHC _t 3(, dale <br /> urfess otherwise spec ied it the Inspection Rep^.^.. HSC 25185(c;(sj <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 lji--c site r,:us*inci4�;: <br /> • A statement docurrer,ting what correcli:e actions N'Sre tatter: or •will be,aksr for each violation <br /> • Copies of sample results/manifestsltrainirg recordsfother appropriate paperwork, and!or photos <br /> verifying corrections _ <br /> • Operator s certification <br /> i <br /> r ' •, inspected By'Elm na ManZo <br /> - <br /> Inspection Gate: -.�L.�y------- -- --------- I <br /> _ I <br /> EPA f D <br /> iJ L_�.. � ' '-� ir: -�J�— <br /> Facility Address: P �` L <br /> 1 <br /> certfiy .,n-4er penalty of law that: 1 <br /> j <br /> l 1 ! have corrected the violations specified in'tie {nsFection Reyart f,o tr,t above-rr,en:.unec: i <br /> Qtspect�cn date. <br /> ! 2. ' Pave parscr.olTy'trYarrined,he followirig documen,latiar.sob tti-r± as proof of compliance -4R <br /> ,TACH VIOLATION a,to : believe the i;lfermaticn to ue 6-ue, 2-7^zurate, and complete: <br /> i <br /> Photos�_-PaperNvorR Statement <br /> I 3. t art►authorized to submt this oartif�cat:cn:u:behaif of tate Respondent 1 <br /> 4. t am aware that there are stgnif"nit PP-nalt:es for subrnimng false irdumiation, including the <br /> possibility of a fine and/or irmprisonment for known violations. (HSC 25119f1) <br /> Narm: T L 71L� <br /> Signature: Oate: C>' �? 1� <br /> EHo R&w0U1W1z RECEIVLL .. <br /> MAY 0 7 2014 <br /> L'd Z 1,,KK9809 joegjepn <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />