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San Joaquin County <br /> Environmental health Department <br /> 868 East Hazelton Avenue, Stockton, California 95205 6232 <br /> Te/eph ne: (209)468-3420 Fax:(209)468-3433 Web:www sigov org/ehd <br /> RET RN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in he "Notice to Comply' in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This ertification 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 violatio s 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. NSC 2518 (c)(3) <br /> Note: All EHD staff time a7,sociated with fzilin,g to comply by the above noted dates will be <br /> billed at the curr nt Hourly rate. <br /> For this certificatio to be complete, the operator of the site must include <br /> A statement documen ing what corrective actions were taken or will be taken for each violation <br /> Copies of sample res ItshTnanifests/training records'other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certificatio <br /> Inspection Date: May 2, 2017Inspected By: Stacy Rivera <br /> Facility Address: 713 EL DORADO '-r CERS ID: 10184731 <br /> I certify under penalty of law t at. <br /> 1 1 have corrected the vi lations specified in the Inspection Report from the above-mentioned inspection date <br /> 2. 1 have personally exa pined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the infori nation to be true, accurate, annomplete <br /> Photos N/ Paperwork Statement <br /> 3. 1 am authorized to sumit this certification on behalf of the Respondent. <br /> 4. 1 am aware that Cher are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment r known violations. (HSC 25191) <br /> N a m e6lat len1✓t��lc, <br /> Date: <br /> Signature: __ <br />