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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 inspechon 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 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: February 14, 2018 _ Inspected By: ELIANNA FLORIDO <br /> Facility Address: 2905 W BENJAMIN HOLT DR, STOCKTON CERS ID: 10181335 <br /> I certify under penalty of law that <br /> 1 1 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 Paperwork e-_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 /> and/or imprisonment for known violations (HSC 25191) <br /> Name:.UG__ d�.t1�----- Title <br /> __Date <br />