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4 <br />San Joaquin County <br /> BEGEA <br />1868 East HazeIton Avenue, Stockton, California 95205-6232 <br />Environmental Health Department WO 1 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: wvvw.sjgov.org/ehd N\j‘Tur4,'‘ N-T E <br />DFPARI-ME <br />RETURN TO COMPLIANCE CERTIFICATION' <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: January 04, 2018 Inspected By Robert Lopez <br /> <br />Facility Address: 10536 TRINITY PKWY CERS ID: 10186771 <br /> <br />ED <br />I certify under penalty of law that: <br />I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />I 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 />117 Photos *7 Paperwork Statement <br />I am authorized to submit this certification on behalf of the Respondent. <br />I 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: ic claci <br />Signature: <br />Title: ST0e-e- 4-A)/4-6 Ci <br />Date: