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SANJOAQUIN Environmental Health Department <br /> C 0 U N T Y, <br /> Vo <br /> PD <br /> RECB <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"I&JONIMENTAL <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EH a ;,4 MjPPRTMENT <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(cXl) <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 gin' ' <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 /> VN' <br /> IN <br /> For this certification to be complete, the operator of the site must include; r <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resuWmanifests/training records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: August 30, 2018 Inspected By: ZONA BARKER <br /> Facility Address: 3425 TRACY BLVD,TRACY CERS ID: 10181087 <br /> 1 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 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:iff 15WAI_&f fI—A-1 —Title:— &W,-r raz", <br /> Signature:_/0%0�4 A,--- Date: 9//7- - /g <br /> 1868 E.Hazelton Avenue 1 Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd,com <br />