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Jan 04 2019 11:10AM Dave Robinson 209-751-2157 page 6 <br /> S A N jiJ OA Q u I N Environmental Health Department <br /> CDUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Ary MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days of <br /> receipt cf this inspection. This certification form must be submitted to the Environmental Health Department(EHD)ad ress <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/manifestsltraining records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: July 10, 2018 Inspected By: ROBERT LOPEZ <br /> Facility Address: 4899 S AIRPORT WAY, STOCKTON CERS ID: 10186725 <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 n <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. t 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: f� — Title: -Sack <br /> Signature: �-t� 1, _ Date: VIOLI-, 21r <br /> lV1NI2W110WN3 . . <br /> J7 <br /> AN 04 2019 <br /> 61OZ � O Ndr <br /> ENVRONVENTAL ' <br /> r7 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.corn <br />