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"T"WIT 1 1 <br /> A.. SANJOANIN <br /> CT <br /> Greatness arov s hero. AN' Z0118 <br /> RETURN TO COMPLIANCE CETIF <br /> Any MINOR violations noted in the`Notice to Comply'In the attached Inspection Report must be co ' � i��& 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(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 falling 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 <br /> corrections <br /> Operators certification <br /> Inspection Date: January 25, 2018 inspected By: BETTY HO <br /> Facility Address: 3725 N TRACY BLVD,TRACY CERS ID: 10181411 <br /> 1 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 2 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 tine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name:_G H 1 TT A-L _9"Prf Title: HOU nt n Q0 Ct? <br /> Signature: Date: <br /> 1868 E.Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />