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Environmental Health Department <br /> SANt%10AQUIN <br /> �jo ';::. CC UNTY yy <br /> AUG 0 3 ? 013 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> ENVIRC) ^ZIMEiv AL <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must bojcfflr� 16&witin "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 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 : July 13 , 2018 Inspected By : CESAR RUVALCABA <br /> Facility Address . 37400 S BIRD RD , TRACY CERS ID : 10187437 <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 VIOLATION <br /> and I believe the information to be true , accurate , and complete : <br /> Photos ✓ Paperwork VStatement <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, C) din -ex 1 'D.(20 Y/^ Title: FnV \ ( C) Offlty�+ Coardi � G��U✓ <br /> Signature : (9Jh Date: <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 1 F 209 464 -0138 1 www . sjcehd . com <br />