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l <br /> i <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www sicov org/ehd <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 tap of this form within 30 days of receipt of the Inspection Report. H50 26404.1.2(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 billet <br /> 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: August 21, 2019 Inspected By: Cesar Ruvalcaba <br /> Facility Address: 7635 S Inland Dr CERS to: 10484737 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Reportfrom the above-mentioned Inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION e <br /> I believe the Information to be true,accurate, and complete: <br /> _Photos_Paperwork_,Statement <br /> I <br /> 3. 1 am authorized to submcertification on half of the Respondent. <br /> 4. 1 am a a t e a significant penalti for submitting false Information, including the possibility of a fine and/o <br /> impris nme � kn Ni violations. (HS 5191) �" ( <br /> Name: Title: ` �"1i�1 the <br /> i <br />