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`n San Joaquin County <br /> Y/ Environmental Health Department <br /> q 1 68 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Lh ���QTeleph ne: (209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd <br /> ET RN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in th "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This c rtification form must be submitted to the Environmental Health Department(EHD) address; <br /> the top of this form within 30 day of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations oted in the attached Inspection Report(IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted us ng 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 ti a associated with failing to comply by the above noted dates will be <br /> billed at the curren hourly rate. <br /> For this certification o be complete, the operator of the site must include: <br /> A statement documentin what corrective actions were taken or will betaken for each violation <br /> Copies of sample results manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: March 2, 2016 Inspected By: CINDY VO <br /> Facility Address: 10 N E T STOCKTON EPA ID: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the viola ions specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally exami ed the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> believe the information W be true, accurate, and complete: <br /> _Photos _Paperwork Statement <br /> 3. 1 am authorized to subm this certification on behalf of the Respondent. <br /> 4. 1 am aware that there ar significant penalties for submitting false information, including the possibility of a fine and/ <br /> imprisonment for known iolations_ (HSC 25191) <br /> Name: vim- Title: <br /> Signature: �� ILI_ Date: 3 16, <br />