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rt cei.3i 9 <br /> VkF <br /> RIL 2 � D <br /> SAN J O A Q U I N SPR 2 4 20 1 .3 environmental Health Department <br /> cnijN rY <br /> ENVIRONMENTAL. f EALTH <br /> RETURN TO C (:WftJAWdt 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 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 <br /> corrections <br /> Operator' s certification <br /> Inspection Date : April 15 , 2019 Inspected By : CHRISTINE LAWRENCE <br /> Facility Address : 22339 E RIVER RD , ESCALON CERS ID : 10186285 <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 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 : \fie c\\ ku `� , c yam Title : U �� Au ,Er .rtvCj, yr <br /> Signature :��J�, ,� Date : <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464- 0138 1 www . sjcehd . com <br />