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,PJ <br /> a Environmental Health Department <br /> ;' I' LL - }l `' ` _� ... , , ? . <br /> 0. Ci '& y q 174Y1 tI oijr,i4 n <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 inspection . This certification form must be submitted to the Environmental Health Department ( EHD) address at <br /> the bottom 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 corrections <br /> Operator's certification <br /> Inspection Date . January 29 , 2020 Inspected By : ELIANNA FLORIDO <br /> Facility Address : 7611 S AIRPORT WAY, STOCKTON CERS ID : 10181317 <br /> certify under penalty of law that: <br /> 1 . I 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 V Statement <br /> 3- 1 am authorized to submit this certification on behalf of the Respondent . ' <br /> 4 . I am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or <br /> imprisonment for <br /> known violations. ( HSC 25191 ) ,�/� <br /> Name: /knmr6oK / " GS 6 "a Title : VES 504 c A/ Al <br /> Signature : Date : off - ZaZc� <br /> �7 o* C'14X16; 1 / / 1 <br />