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SAN JOADIN <br />Environmental Health Department <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MI_ NO yiokahons noteo ,n the Notice to Comply m the anact•ed InK( ecbon RLp +'' •*,usl be Wt= *-Ihjn 34 4 of <br />receipt of tniS in%*Ction This CrrllhcaLon form must be submitted to me Enoronrrtental Health Department fEHO' address <br />at the top of th 15 form within 30 aays of receipt of the Inspection Report HSC 25404 1 2(t J( 1 I <br />All rr I to 011f vi t. on s noted in the attachea Inspection Report flRa or Conunuatron Form or disputes to any <br />violations are to be submittea usmg th s Certification and retumed to EHO writhm 30 days unless otherwise speohed in the <br />Inspection Report HSC25185(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 sae must Include <br />A statement documenting what corrective acwons were taker} or will be taken for each violation <br />Copies of sample res ultsmandests;vammg reoordsiother appropriate paperwork andior photos yeIIlyIng <br />ccfreclon5 <br />Operator s certification <br />Inspection late: May 17 2018 Inspected By: JAMIE LIMA <br />Facility Address: 720 E HAMMER LN, STOCKTON <br />I certify unser penalty of law that <br />CERS ID: 10182965 <br />1 1 have correcteo the viOlabons specified in the InspeCton Repon from the above-mentioned inspection date <br />2 1 have personally examined the foNywing documentation submitted as proof of Compliance FOR EACH VIOLATION <br />and I befem the information to be true accurate aria complete <br />Pnotos Paperwork --v/—Statement <br />3 1 am authonxed to submit this certthcabon on benalf Of the Respondent <br />4 t am aware mal there afe sig mhcan117enalfies for submitting false mformatton. inGudmg the poss,bdrty of a fine <br />and or imprisonment for known ndatfons IHSC 25191) <br />.1 [- <br />Name _YYU Title: li►D Zr�ris4 T <br />Signature Date <br />RECE11fl- <br />'j <br />. <br />n� <br />t , ENTAL_ <br />--� Avenue I Stockton Califnmra 95205 I T 209 46&i4201 F 209 464.0138 1 www s)cehd can <br />