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`- ' r SAN �JOAQUIN Environmental Health Department <br /> L -- COUNTY — - <br /> - . �,, �,,.-" Cirw� rneit yrori5 hers. <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 /> 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/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: February 14, 2019 Inspected By : ROBERT LOPEZ <br /> Facility Address: 1810E HAZELTON AVE , STOCKTON CERS ID: 10181545 <br /> I certify under penalty of law that: <br /> 1 . 1 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 <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that the re significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonm t f r known ULM *lqw�oolations. (HSC 25191 ) n <br /> Name: Pol'✓)bf� Title: MA✓#Zeml �1 hr"915eUA <br /> Signature: Date: Z'2�- / � <br /> 1868 E . Hazelton Avenue Stockton , California 95205 1 T 209 468-3420 1 F 209464-0138 1 www. sjcehd. com <br />