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Apr 17 2011 : 24a p , 2 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web. www.sigov .ora/ehd <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 <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 Qtherviolations 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. MSC 25185(c)(3) <br /> Note : All EMD 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 resultslmanifests/training recordsiother appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date. April 08 . 2019 Inspected By . John Alaniz <br /> Facility Address : 840 E JEFFERSON STCERS ID : 10787629 <br /> I 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 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 . (NSC 25191 ) <br /> Name; }u-CA t t t- re..t X11(A aJ e Z Title: C>W n e R <br /> Signature: Date: ' " z <br />