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Environmental Health Department <br /> SAWtJOAQUIN <br /> C-OLJ NI Y <br /> tMED <br /> oE <br /> REC <br /> RETURN TO COMPLIANCE CERTIFICATION SEP Ila, 2018 <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 3Q�+�+�i�0N1V1ENTAL <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHflfgs�l OF'P•e RTYIENT <br /> at the lop 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 7-,) <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise speclfied�1 ft �, µ Y 4 <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:i!.i' 2f 01'3 <br /> billed at the current hourly rate, ry _ <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 <br /> corrections <br /> Operator's certification <br /> Inspection Date: August 30, 2018 Inspected By: ZUNA BARKER <br /> Facility Address: 3425 TRACY BLVD,TRACY CERS ID: 10181087 <br /> 1 certify under penally 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 /> r <br /> Name:Na /Al kAfAl <br /> Signature: At,"��� Date: Z _z2z"0/� <br /> 1868 E.Hazelton Avenue t Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />