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03 fooc> <br /> Environmental Health 7Dartment <br /> �`� • � - ` SANr�:�JOAQUIN <br /> y <br /> 1 ' <br /> :. COUNTY � vve g <br /> �c9t * . Greotness grows here . <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 days of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD) address at <br /> the bottom 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 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 records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator' s certification <br /> Inspection Date . March 047 2020 Inspected By : GARRETT BACKUS <br /> Facility Address . 330 N Grant St , Stockton CERS ID : 10671805 <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 submit ed as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate , and compl <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 and/or <br /> imprisonment for known violations. ( HSC 25191 ) <br /> Name : I` i� /c-1 Title : ��— /� /�,Q •CyGC� <br /> Signature : <br />