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A ,.J 0A 0 U 1 N EnVironrnental Health Department <br /> __...C O U N T Y—.--- <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINS 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(EH0)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 26404.1.2(c)(1) <br /> All correc ions to other violations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violatlons,are to be submitted using tills 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: February 20, 2020 Inspected By: CARRETT BACKUS <br /> Facility Address: 410 S EL DORADO ST, STOCKTON CERS ID: 1078705$ <br /> l 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 submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,and complete: <br /> Photos^ -"Paperwork____rZStetement <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 /> Names l Title: <br /> Signatu Date: <br />