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San Joaquin County <br /> E vironmental Health Department <br /> 1868 East Ha elton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)4E 8-3420 Fax:(209)468-3433 Web:www.s' ov. rcilehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MLNOR violations noted in the"Notice to Compl "in the attached Inspection Report must be coi rooted within 30 days of <br /> receipt of this insp ction. This certification form muEt be submitted to the Environmental Health Dep 3rtment(EH D)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 oth rwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Note: All EHD 3taff time associated with failing to comply by the above noted d ites will be <br /> billed a the current hourly rate. <br /> For this cerl ification 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 Violator <br /> Copies of sample resultslmanifestsltraining records/other appropriate paperwork,and/or ph tos verifying <br /> correctior s <br /> Operator' certification <br /> Inspection Da e: July 15, 2019 Inspected By: John Alaniz <br /> Fact ity Add re s: 2050 E SIKORSKY ST CERS ID: 10182505 <br /> l certif under peni Ity of law that: <br /> 1. 1 have cor ected the violations specified in the Inspection Report from the above-mentioned nspection date. <br /> 2. 1 have pe sonally examined the following d cumentation submitted as proof of compliance OR EACH VIOLATION <br /> and I believe the information to be true, acci irate, and complete: <br /> hotos X Paperwork X Statement <br /> 3. 1 am auth Drized to submit this certification c n behalf of the Respondent. <br /> 4. 1 am awa i e that there are significant pen alti s for submitting false information, including the possibility of a fine <br /> and/or im risonment for known violations. (ISC 25191) <br /> Name: Gu dalupe Gonzalez Title: Director of ivaintenance <br /> Sgnature: Date: May 18 , 2020 <br />