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Nhr . 13 . 2020 11 : 28 AM Parkwoods Cleaners 2094774397 PAGE . 2 / 8 <br /> A <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton , California 85206-6232 <br /> Telephone; (208) 466-3420 Fax. (208) 468m3433 Webc www. sloov. oro/ghd <br /> RETURN TO COMPLIANCE CERTIFICATiON <br /> Anyitvi B violations noted In the "Notice to Comply" In the attached Inspection Report must be corrected witbin 30 daysm of <br /> receipt of this Inspection , This certification form must be submitted to the Environmental Health Department (EHD) address at <br /> the top of this form within 30 days of receipt of the Inspection Report , MSC 25404, 1 , 2(o)( 1 ) <br /> All corrections to otbar 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 Wlthln 30 days unless otherwise specified in the <br /> Inspection Report. H$C 25185(o)(3) <br /> Nate: All EHD staff time associated with falling to comply by the above noted dates will be <br /> gilled 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 reaults/manifests/training records/other appropriate paperwork, and/or photos verifying corrections ' <br /> Inspection Date : June 09 , 2016 inspected By : FATiNAH ZAREE= F <br /> Facility Address : 1901 GAUNTRY CLUB BLVD, STOCKTON EPA Was C0&!0e)C)9b <br /> I Certify under penalty of law that: <br /> 1v i have corrected the violations specified In the Inspection Report from the above-mentioned Inspection date. <br /> 2 . I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and � <br /> i <br /> 1 believe the information to be true, accurate , and complete : <br /> Photos _ _ 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 fine and/or ' <br /> Imprisonment for known Violations, (HSC 25191 ) <br /> i <br /> Name ; Title ; <br /> Signature ; — <br /> Date: <br /> 61 <br /> �' �3 2020 <br />