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SANAMIN Environmental Health Department <br /> ---C DU NIT Y— <br /> .. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> "MINOR Wdafmns noted in 0e"Notice to ComoV in the stormed Inspection Sidi must be comerdead within 30 di of <br /> receipt of this inspMon. This comomeon form must W submittetl W the Eneronmenld Heath uspadment(EHO)address <br /> atlbemp ofthis fotmtWtbin 30mi 0 rexipt aft Inspection RepaM1 HSC25404,12(chl) <br /> AU noted in the aHacbetl Inspection Report(IR)or Continuation Form,or disputed to arry <br /> Woktions are W be submitted] using this cerlificalion " seemed]W EH9 within 30 died unless anemone meremed In Ne <br /> hapredoon Report. HSC 25185(c)(3) <br /> Note: All END 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&the site mostlndade: <br /> A statement documenting what mnaclhm before were taken or out be taken for each vionfe n <br /> Copes msange resuwmaniastavammg mobarmther appmpdaze paperwork,andfor gwtoa vedtyiig <br /> mrrecuon <br /> Operator certification <br /> Inspection Date: dune27, 2019 Inspected By: ROBERT LOPEZ <br /> Facility Address: 3923 5 B ST, STOCKTON CERS ID: 10771885 <br /> I Certify nosier penalty of We that <br /> 1. I have consoled the stations;specified in the Inspecinn Report from the altm emenllonetl inspection dale. <br /> 2. 1 have pe2onaAy examined the folowing documentation submitted as pi of astrolabes FOR EACH VIOLATION <br /> and l believe the iMotmatiw to be and, accurate, and cwngease <br /> Phdos—x—Paperwark_Statstnent <br /> 3. 1 an statistical to submit this wHirrcedon on b&aff ofthe lowboo aM <br /> 4, lam aware thatthere are aifrificm produce for submltNg robe information, intlWirg to lwsalLWlty of a fire <br /> and/wpnprisonment(orkM1nown Wdations. (HSC25191) <br /> Name:�PfNct.. \�Oy Title: ib l'l� �C`S I"\o'nacycwj <br /> Signature: Date: �Z I2W � r <br /> 1888E. Hareltongvenua Stockbq Cali(omie 952051 T 20941 F 2094 0135 1 www,slcehdmm <br />