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06/07/2019 89:02 209-836-2564 FEDEX OFFICE 1469 PAGE 04 <br /> RECEIVED <br /> SbFt<�UQ4 � AU6 U ) 219 Environmental Health Department <br /> C,OUNNT4Y....... <br /> here. ENVIRONMENTAL HEALTH <br /> 4. Greatness grovta <br /> PERMIT/SERVICES <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted In the"Nonce to Comply° in the attached Inspection Report must be wi h'n 30 des of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address at <br /> the bottom of this form within 30 days of receipt of the Inspection ReporL HSC 25404.1.2(e)(1) <br /> Allooritcf ro [her violations noted in the attached Inspection Report(IR)or Continuatlon Form,or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within days unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Now All EHD staff time associated with failing to comply by the above noted daces 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/manifestenraining records/other appropriate paperwork, and/or photos verifying corrections '.. <br /> Operators certification '.. <br /> Inspection Date: July 23, 2019 Inspected By: CESAR RUVALCAHA <br /> Facility Address: 17000 LOWER JONES RD, STOCKTON CERS ID: 10484881 <br /> 1 certify under penalty of law that. <br /> 1. 1 have Wi ected the violations spedfled in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as Prager compliance FOR EACH VIOLATION and <br /> I believe the information to be We,accurate,and complete: <br /> Photos______Paperwork _Statement <br /> 3. ]am authodzed to submit this certification on behalf of the Respondent. <br /> 4. Lam aware that there are significant penalties for submitting false Intension,Including the possibility are fine and/or <br /> imprisonment for known violations. (HSC25191) <br /> Name: e5;,A�/ ICZ4'oerll' Title: ,,ass/- ,;;,r,7 M.w✓n., <br /> *411 ✓ro&A'�W$ Wye Co¢R�tr6sD o.J 5.lc.. <br /> 1868 E. Haze Ron Avenue I Stockton, Califomia 952051 T 209 468-34201 F 209 4640138 1 www.sjcehd.com <br /> Received Tlme Aug, 7. 2019 9'AIAM No. 5349 <br /> 7 <br />