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SAN J Environmental Health Department <br /> COUNTY <br /> RETURN TO COMPLIANCE CERTOFICATION <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 /> HDD AHD staff Ehme asocoated with failing to (cornp V by the above noted dates will be <br /> WH00od at the currenct hour0y rate . <br /> For `kh' s c erLT u cation 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 : September 12 , 2018 Inspected Bye, ROBERT LOPEZ <br /> Fac ' Ky Address . 3310 E MINER AVE , STOCKTON CERS 11) 0 10182721 <br /> certify under penalty of law that : <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 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 : v zc i1 � c v Title : v � < <� d � .rtQ ✓ � � 144 i <br /> Signature : Date : � � � ( 2 1 ( 6 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 F 209 464 -0138 1 www . sjcehd . com <br />