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Jun 13 18, 03:44p p,1 <br />I <br />San Joaquin County RECEIVED JUN 1018 <br />Environmental Health Department <br />868 East Hazelton Avenue. Stockton, California 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.orglehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected with ri. 30 days of <br />receipt cf this inspection. This certification form must be ubmitted to the Environmental Health Department (END) address <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(,) <br />All correct.ons to other violations noted in the attached Ins ection Report (IR) or Continuation Form, o. disputes to any <br />vioations, are to be submitted using this certification and raturned to EHD within 30 days unless othe wise specified in _he <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 talon or will be taken for each violation <br />Copies of sampie results/manifests/training recordslother appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certifcation <br />Inspection Date: March 30, 2018 <br />Facility Address: 1987 W ELEVENTH ST <br />1 certify under penalty of law that: <br />Inspected By: <br />CERS ID: 10156819 <br />1. € have corrected 'the violaticns specified in theinsolection Report from the above-mentioned inspection date. <br />2. 1 have personally examined the fo!lewing dccumerttation submitted as proof of compliance FOR EACH VIOLATION <br />and I be)ieve the information to be true; accurate, andd complete: <br />Photos ✓ _Fa,oenvork r Statement <br />3. 1 am authorized to submit this certificafon, on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a line <br />and/or imprisonment fer known violations. (HSC 2519 1) <br />Y_ <br />Name: �''� L -�- Title: <br />Signature:_—�� Date: .._�� _ <br />`) Y �- <br />✓ 4 ` Ate- y� V <br />�_l <br />