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S AW, J O AH I N Environmental Health Department <br />COUNTY <br />Greatness grows here, <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 3( <br />receipt of this inspection, This certification form must be submitted to the Environmental Health Department (EHD) <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to a <br />violations, are to be submitted using this certification and returned to EHD within 30 dans unless otherwise specified <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 records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certification <br />Inspection Date: November 02, 2018 <br />days of <br />the <br />Inspected By: NICHOLAS 1 OEHRI R <br />Facility Address; 25775 S PATTERSON PASS RD, TRACY CERS ID: 10181249 <br />I certify under penalty of law that: <br />1. I 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 />and I believe the information to be true, accurate, and cote: <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 <br />and/or imprisonment for known violations. (HSC 25191) <br />Name:_ t Qw `b 1_ Title: <br />Signature: <br />Date: <br />/L_ <br />1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjce4com <br />