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Environmental Health Departure <br /> tu <br /> +� FREC <br /> AtrZ ( txpit <br /> J R 0 J 2018 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br /> F /�I_T [ FP_3_0 VE o <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be cor c e wl hin 36 ays 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 othelr 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-111-da unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Note: All EHID 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 /> Operators certification <br /> Inspection Elate: April 02, 2018 Inspected By: ROBERT LOPEZ <br /> Facility Address: 1807 NAVY DR, STOCKTON CERS ID: 10185045 <br /> 1 certify under penalty of law than <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 complete: <br /> Photos Paperwork Statement <br /> 3- 1 am aurhnrbad fn ai ihmit this cartiflr-ation 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: Title: pn�5I unj <br /> Signature: <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 4B8-34201 F 209 464-0138 1 www.sjcehd.com <br /> Received Time Apr. 9. 2018 10:58AM No. 3338 <br />