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SAN JOANIN Environmental Health Department <br /> c r.;t i.1 i Y <br /> „R t !!� r <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any-MINOR NOR violations noted in the`Notice to Comply"in the attached Inspection Report must be corrected Abin 30 day@ 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 wither 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHl]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/manlfesta/iraining recordslother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: December 28, 2018 Inspected By: GARRETT BACKUS <br /> Facility Address: 7679 LONGEST,STOCKTON CERS ID: 10184659 <br /> t certify under penalty of law that: <br /> 1. I have cormctad 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 .t/ Paperwork t/Ststement <br /> 3. 1 am authorized to submit this oertification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting Use information,including the possibility of a fine <br /> andlor imprisonment for known violations. (HSC 25991) <br /> Name: 1T r`/ffz@ ISI �jfJ LtJ✓1 Title: .1>1041 W'31;7wd1�t e <br /> Signature: Date:- "7 VM r <br /> 1868 E. Ha-afton Avenue' Stockton,California 952051 T 209 468-34201 F 209 464-01313 1 www.sjcehd.com <br />