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San Joaquin County �- �� � i� <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-62 <br /> Telephone: (209)468-3420 Fax:(209)4683433 Web:www.sjgo_y�ralehd ' <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be gorrected with0_2QjgW 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. HSG 25404.1.2(c)(1) <br /> All corrections tp 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 unless otherwise specified in the <br /> Inspection Report. MSC 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 corrections <br /> Inspection Date: August 22, 2017 Inspected By: VICKI MCCARTNEY <br /> Facility Address: 7700 MORELAND ST, STOCKTON CERS ID: 10181359 <br /> Fc-e-r-u;under penalty of law"t: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. [have personally examined the following documentation submitted as proof f compliance FOR EACH VIOLATION <br /> and I believe the infgrmatign 0 be tq t�,accurate, and complete: r� C���-'-��► �- <br /> t Photos Paperwork t—" 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 and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: 1� A ar ok Tt (;s L L Title: 60 `— of o f+C..c4t <br /> Signa Date: <br /> RECF131-A <br /> SEP 2 0 2017 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />