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S A � ��� O A `D U f � Environme Rl�e.� t� IDepartmant <br />¢ F v I <br />JAN 11 2018 <br />RETURN TO COMPLIANCE CERTIFICATION <br />EWIRONMENTAI._ HEALTH <br />Any MINOR violations noted in the "Notice to comply' in the attached Inspection Report must be corrected WIM— i 16—D ENT <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 falling 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 taksn 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: <br />December 27, 2017 <br />Inspected By: <br />NICHOLAS LOEHRER <br />Facility Address: <br />24124 N BRUELLA RD, ACAMPO <br />CERS ID: <br />10181429 <br />I certify under penalty of law that: <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 I,ACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <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 fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: airu-n 1 �1� _ y1r�. Title: , Cl <br />-����� <br />Signature: Aon � Date: <br />1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209468-3420 1 F 209464-0138 1 www.sjcehd.com <br />Received Time Jan.11, 2018 9:54AM No -2874 <br />