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SAN J A I I I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Ary MINOR violatIM3 rioted in the'Notice to Comply"in the attached Inspedon Report must be cot ectad vAhjn 50 dogs or <br /> receiiptafOh n inspection_ This o�3rtficmjor.form must be submitted to Tho En-4ciri mental 4ealth Department IEHD)2ddresg at <br /> the btiltbm of chis form within?4 days of receipt cf ft knspection Report. HS'—25404.1.2(c)(1) <br /> All owroctions to other violations noted :rn the attached Inspinn Report(IR)ior Continuation f=orm, or disputes;o amY <br /> „ictak+ons, are to be subrrAted using this certification and fetun-ec to EhD hirr',5 d �unless o�herviise specified in the <br /> Inspection Lenon, HSC 25185(c)(3) <br /> Note: All EHD shaft time associated with failing to rurrtply tay the above ironed dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, th a cperator nr the site must includa_ <br /> A atatemen-docmmenti.lg what cnrrecbive acborrs we:Ta taken er will be talSen for each viola9cm <br /> Copses or 6ernple resulrWrnanikmtsftraininq recardafother appropriate paperw n� <, and+or:Dhotog verifying couoct:oris <br /> Operator's oertlfcation <br /> InspectionDate: March 10, 2020 Inspected By: JASON GAITAN <br /> Facility Address: 15380 S MOKI LEY AVE, LATHROP CERS ID: <br /> certify under pe-lalty of law that <br /> 1. 1 have=necked the vioi2tibrl..cparillari 3n the Inspection Report frorn the atone-mentioned inspection date. <br /> 2_ 11 idues personally exerninctl the fallowing coowfnontation:ubmitte•d as proof of campliance FOR EACH V1OLATION <br /> and I believe the Irrrormatlon W be lrt,ie, accurate, and wmpiwe. <br /> Rhotori__ Praper%vorlc Statemem <br /> 3. l am authorized'a submtt this certlf:catlon on behalf of the Responders <br /> 4. 1 circ aware thst there Ei a signrFicamt penaIes for submii#ing false Vormation including the possiibillty of a fine <br /> and?erimprisonrrentfor Known Aolations, (HsC251t31) <br /> Dame' <br /> Signature._ [date r 0 0 <br />