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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.sigov.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 /> 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(I R)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 /> Inspection Date: September 27, 2018 Inspected By: ELIANNA FLORIDO <br /> Facility Address: 1050 N WILSON WAY, STOCKTON CERS ID: 10180707 <br /> 1 certify under penalty of law that- <br /> 1. <br /> hat:1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. I 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 /t• Paperwork 2C_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 /> andlor imprisonment for known violations. (HSC 25191) <br /> �� <br /> Name: l�1 �r1eS� Title; <br /> Signat Date: Z <br /> i <br /> R <br /> EGAED <br /> DEC r 3 2018 <br /> ENVIRONMENTAL. HEALTH <br /> DEPARTMENT <br />