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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.s4gov.org/ehd <br /> RE-TURN 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 certi ication 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 hurly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting hat corrective actions were taken or will betaken for each violation <br /> Copies of sample results/m nifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: Februa 27, 2018 Inspected By: JOHN ALANIZ <br /> Facility Address: 1403 COUNTRY CLUB BLVD, STOCKTON CERS ID: 10183113 <br /> 1 certify under penalty of law that: <br /> 1. I have corrected the violati ns specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examine 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 (�_ Statement <br /> 3. 1 am authorized to submit t is 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/225519/1) <br /> Name: �� 1 =' v Title: �W <br /> Signature: Date: 2,- <br /> RECEIVED RECEIVED <br /> MAR ?6 2018 <br /> ENVIRONMENTAL <br />