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SAN 1 Q A Q U I N Environmental Health 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 END 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 /> Operator's certification <br /> Inspection Date : December 11 , 2018 Inspected By : ZUNA BARKER <br /> Facility Address : 140 E LATHROP RD , LATHROP CERS ID : 10182153 <br /> 1 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 : 1 �� 2 C S� Title :— qtr " 12ear� <br /> Signature : <br /> 7 � ? <br /> 1868 E . Hazelton Avenue l Stockton , California f)52051 T 209 468 -3420 1 F 209 464 -0 138 1 wwN , sjcehd .com <br />