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RECEIVED <br /> San Joaquin County <br /> Environmental Health Department MAR 2 8 2018 <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 - <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:m6nLoov.ora/ehd <br /> �NVIRONMENTAL HEALTH <br /> DEPARTMENT <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 /> Inspection Date: February 23, 2018 Inspected By: ELIANNA FLORIDO <br /> Facility Address: 4800 S AIRPORT WAY, STOCKTON CERS ID: 10181439 <br /> I 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 /> PhotosY- Paperwork M1 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: y n^ .5 �� Title: o GtD,-r IJ d s 0� <br /> Signature: Date: ala 3 <br /> QI'l �(rprv� e..-f � R cY "�a (cQ -� 4.a�r I.c.ler� �fh� a1"oST;naTror <br /> D/SV/`75C) <br /> opy Cr;r�C- <br /> - `. <br /> . ,C f2 SSPerG1-611C 4;,ej f OLL.n & +I-2 Si5 h c7 <br /> / �o r a1r-cY SaICP o�'� -10 r, f/tc1�, -�'a,1� • �ur� " <br /> ��w` :�a� � �✓1-FOrMS. / f0/1 b/'OL(Gh'� '�O I'Uy �Llr^ TIOn <br /> tom /-eSPSrch, It)liS`fe je 74 uJa ND IOs �r A6 � <br /> __pp�c5�ose o �'pCesG�nS Cor s/�oli�G�ecO MGt/► 1 P <br /> Fs fe <br /> �%l 'Sfi'GSec� B� LfSinvC ct �11; OFr"` f- & Z6t..rdeyy �aS <br />