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RECEIVED JAN 14 2019 <br /> ��*+ 'A rr Environmental Health Department <br /> 41 64 <br /> Do <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the ' Notice to Comply" in the attached Inspection Report must be corrected withinthin 30 daysdays 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. MSC 25404 . 1 .2(c)(1 ) <br /> All correotions to ether 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 FHD with p 30 days unless otherwise specified in the <br /> Inspection Report HSC 25185(c)(3) <br /> Note: All EHD staff gime associated with falling to aamply by the above noted dates %111 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 /> Operator's certification <br /> Inspectlon Date: January 14 , 2019 Inspected By : ZUNA BARKER <br /> We <br /> Facility Address: 1960 W ELEVENTH ST TRACY CERS Me 10181657 <br /> too M-oo <br /> certify under penalty of law that, <br /> 1 • I have corrected 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 X Paperwork 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 one <br /> and/or imprisonment for known violations. (HSC 25191 ) <br /> Name: Deborah Rowe Tftle: UST Compliance Coordinator <br /> Signature : ne- a" k"�' Date : January 27 , 2020 <br /> 1868 E. Hazelton Avenue I Stockton , California 952061 T 209488-3420 F 209464000138 I www, sjcehd• com <br />