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San Joaquin County RECEIVED Environmental Health Department 1868 East Hazeiton Avenue, Stockton, California 95205-6232• <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org/ehd MAR 2 7 201 <br />S <br />RETURN TO COMPLIANCE CERTIFICATIONNVIRONMENTAL !HEALTH <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be correcteWHAV+ <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 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 />Inspection Date: March 13, 2017 <br />Inspected By: ROBERT LOPEZ <br />Facility Address: 2900 E HARDING WAY, STOCKTON CERS ID: 0 <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 EACH VIO <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: C�v�J °4; __ Title: <br />Signatu <br />LXi � 0 C -91Q-k 1141- 0 + <br />le �14 1 <br />