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SAN JDAIDUIN 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 torn 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 Farm, or disputes to any <br /> violations, am 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 falling to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> Forthis certification to be complete, the operator ofthe site must include. <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifestsAraining recordslother appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operators certifcaticn <br /> Inspection Date: September 10, 2018 Inspected By: CESAR RUVALCABA <br /> Facility Address: 2500 NAVY DR, STOCKTON CERS ID: 10181569 <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 data <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: (I�g� <br /> Photos Paperwork 'v` 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 <br /> known violations (HSC25191) <br /> NamI IT.Firw� Title: SAFS) 1AAa",-6'GL <br /> Signature: Date: 3/24(✓ <br /> 1868 E Hazelton Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />