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Jon. 29. 2018 6: 31 PM <br />No. 0405 P. 1 <br />San Joaquin County RECEIVED <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 952056232 JUL 0 2 2018 <br />Telephone: (209) 468-3420 Fax: (2o9) 468-3433 Web: www,sig9v.org/ehd <br />ENVIRONMENTAL <br />RETURN TO COMPLIANCE CERTIFICATIOIRI ALTH DEPARTMENT <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <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 any <br />violations, are to be submitted using 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 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: May 10, 2018 <br />Facility Address: 1400E WATERLOO RD <br />I certify under penalty of law that: <br />Inspected By: <br />Robert Lopez <br />CERS ID: 10182037 <br />1. 1 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/T� <br />believe the information to be true, accurate, and complete: <br />V 0 ^`yVbS�c <br />ZPhotos Paperwork Statement <br />3. 1 em 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 fine <br />and/or imprisonment for known violations. (HSC 25191) <br />--- _ <br />Thle: <br />r� @ <br />Signature: Date: 4C�ii✓U� �� <br />)4,46� <br />