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Environmental Health Department <br /> SAN',-.JOAQUIN <br /> C-C."L, N 1 Y F-a 1tel 11�j <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN 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 <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(I R)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD in 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 recordslother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: August 30, 2018 Inspected By: ZUNA BARKER <br /> Facility Address: 3425 TRACY BLVD,TRACY CES ID: 10181087 <br /> I 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 subrrdfted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,and complete: <br /> Photos I 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 /> -�Wkj L izemil, CfM7LI$kKZ7 Gay `T <br /> Name: Title: <br /> Signature: 'Date: <br /> RECEIVED <br /> SEP 2 8 2018 <br /> ENVIRONMENTAL HEALT8 <br /> DEPARTMF?,,,!-1- <br /> 1868 E.Hazelton Avenue Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />