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San Joaquin County <br />Erma-onmental Health Department <br />1868 East Hatt+!ton Avenue, Stockton, California 95205 6232 <br />Telephone- ;209) 468-3420 Fax: ;?091468-3433 Web: -wwv ;�igrjo ' o,g: rn <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any. MINOR violations noted in the 'No'u'n to Cor^p1y' in the attached Inspe non Report must be gorrected with:n 30 days of <br />Mceiat of this inspection. This oertificatior, form must be submitted to the Ervironrnentai Health Deparment (EHDi address <br />at the too of this form within 30 days of receipt of the Inspection Report HSC 75404.12(c)(1) <br />All corre..;tinnS-to _oth^_` violations noted in the attached Inspecton Report (IR) or Connnuat , Form, or disputes to any <br />vi0l3t;0,1ls. are to be submitted using tnis oertificaton and returned to EHD within 30 dans unless othervvise specified in the <br />Inspection Report HSC 25'85�,cid3:, <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 operatar of the site must inc,'ude: <br />A statement doc urrientng vonat correclxe ac:ions were :aken or wife be taken for each violation <br />Copies of sample results ni arifcsts,ttaining r-corrscrcther approp-iate papenvorK, andror photos verifying corrections <br />Inspection Date: Match 31, 261 T <br />Inspected By: VICKI MCCAN f NEY <br />Facility Address: 25775,S PATTERSON PASS RD, I-RL',CY <br />I Certfy undo• penalty of iaw'hat: <br />CERS ID: 1 C 181249 <br />1 1 have correctc-d tt-:e violations sp+ecifiL–J m the Inspection Report from the above-mentioned inspecnor date. <br />? 1 have porsora1y examined the following docurnentanor, submitted as proof of cornp,,iance FOR EACH VIOLATION <br />and I tklieve the mformat)on t0 be true accurate, and complete % <br />Photos _Papers; rk �' / Statement <br />3. 1 am 3utt?onted to submit this cert)frcabDri on beh31 of the Respondent <br />4. 1 am avnre that t1l7,[;re are s gni5a3nt penaltics for submitting false information.including Ute puss:b:liy of a fine ana'q <br />imprisonment for krxa+vn violat+cns (HSC 2519' i <br />Name: �1 �-- Title: —� ` i iu %fi� L -- <br />Signature: - Date: 'S / �) <br />RECEIVED <br />APR 17 2017 <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />