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F.a: gyve_ <br /> r. <br /> IN Environmental Health D <br /> � apartment <br /> ` RETURN TO COMPLIANCE CERTIFICATION <br /> OR ns <br /> ed in the <br /> tice to <br /> - 1pt o thiswinspecdon.[This certification formomply,in must be the attached inspection Rol must be corrected within 30 da s of <br /> submitted to the En ;i 5440044.1 Health Depanment(EHD)address <br /> at the top of this tone within 30 days Of receipt of the Inspection Report. HSC --� <br /> 2(c)(1) <br /> ioAil corrections o be Submitted other violations noted in the attached Inspection Report(IR)or Confiouation Form, <br /> Inspection Report. HSC 25185(c)(3)this certification and returned to EHD within 3 <br /> or disputes to any <br /> within unless otherwise specified in the <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 <br /> . A statement documentingwhat Lb , [he operator of the site must include:rective actions were taken or will be taken for each violation <br /> Copies of sample results/manifeststtraining records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: November 01, 2017 <br /> Inspected By: CESAR RUVALCABA <br /> y Facility Address: 830 S California St, Stockton <br /> CERS ID: 10707730 <br /> Fm <br /> er penalty of law that: <br /> s <br /> ve corrected the violationsspecified in the Inspection Report from the above-mentioned inspection date. <br /> ve personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: <br /> Photos PaperworkStatement <br /> authorized to submit this certification on behalf of the Respondent. <br /> aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> rjm risonment for kno n violations. (HSC25191) <br /> K J Title: <br /> : o ate: �1 I 221 I <br /> RECEIVED <br /> jV z z zof) <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT 1 <br /> 11 � <br />