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San Joaquin County <br /> Environmental Health Department <br /> 1866 East Hazelton Avenue,Stockton,Califomis 95205.6232 <br /> Telephone:(209)468-420 Fax:(209)4684433 Web.www.slsov.om1ehd <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 inspectlon. 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 26186(c)(3) <br /> Note: All EHD staff Urne 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 taken for each violation <br /> Copies of sample results/manilestsltraining records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Inspection Date: September 26, 2018 inspected By: HAZA SAEED <br /> Facility Address: 18362 E HWY 4 , Stockton CERS ID: 10422613 <br /> 1 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 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: Steve Mills Title: Maintenance Coordinator <br /> Signature,-,_ Date: Oct 03 2018 <br />