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SAN JOAOUIN <br />-"iTy <br />Environmental t Department <br />RETURN TO COMPLIANCE CERT!Ffr..A <br />Any MINOR violations noted in the " � <br />receipt of this inspection. Notice to Com I mental Health �epartme a�f <br />at the to This certification form must bettsubm nE tin 1 d rasa <br />p of this form within 30 days of receipt of the Inspection+• rr� <br />All corrections to �' HSC 25404.1.2(c)(1) <br />violations other violations noted in the attached Inspection Report (IR) or Continuation >`orni, or disputes to any <br />are to be submitted using this certification and returned to EHD w' <br />Inspection ReportHSC 25185(c)(3) ithin 30 days unless otherwise specified in the <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 />0 pies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br />w: rections <br />Operator's certification <br />Inspection Date: <br />Face' #dress: <br />July 24 2018 Inspected By: ROBERT LOPEZ <br />2211 W ALPINE AVE STOCKTON <br />«' denalty of law that: <br />CERS ID: 10180773 <br />I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos _Paperwork Statement <br />3. 16°)i 1horized to submit this certification on behalf of the Respondent. <br />4. 1 am stare that there are significant penalties for submitting false information, including the possibility of a fine <br />44Wor imprisonment for known violations. (HSC 25191) <br />Name: 1 �, l <br />fll TiltIP� <br />Signature: <br />Date: F <br />1868 E. V "Zelton Avenue I Stockton, California 951.up ' T 209 468-3420 F 209 464-0138 www.sjcehd.com <br />