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Jul. 9. 2018 3:4b PM No, 1908 P. 2 <br /> >•. . Environmental Health Department <br /> � . <br /> •. `s,..f�.l*:,..�� �c o Irl N TY <br /> E �..,� i o :tom <br /> RETURN TO COMPLIANCE CERTIFICATION JUL 0 9 2018 <br /> Iir�nn±gl!i!ENTA� <br /> Any MINOR violations noted In the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days of .T P 7NT <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 2gfoctions 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 EHO within 30 days unless otherwise specified in the <br /> Inspection Report. NSC 25185(c)(3) <br /> Note. All EHD staff time associated with failing to comply by the above noted dates Mill 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: June 08, 2018 Inspected By: LYDIA BAKER <br /> Facility Address: 4520 EIGHT MILE RD, STOCKTON CERS ID: 10182013 <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 1 believe the Intonation to be true, accurate,and complete; <br /> & Photos_Paperwork c' 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: J 42!'1 h I�e r C%trGt Title: 50-n l or P oo k 0 c) r 6-c <br /> Signature- Date: <br /> 1868 E. Hazelton Avenue I Stockton,California 952051 T 209 400-34201 F 209 464-0138 1 www.sjcehd,com <br />