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SAN JaAQuiN Environmental Health Department <br /> C_ 0 U 1441 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the ;" Notice <br /> form muust be submitted to the EnviInspection <br /> ro mental Heal h Departmen ( EHD) 0 d s f <br /> receipt of this inspection . This certification <br /> at 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 /> Jul 22 , 2019 Inspected By : JOHN ALANIZ <br /> Inspection Date : Y <br /> Facility Address : <br /> 540 N GRANT ST , STOCKTON CERS ID : 0 <br /> r2) <br /> y under penalty of law that: <br /> I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . <br /> . 1 have personally examined the <br /> following documentaturate , andion <br /> comp emitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to <br /> Photos ' Paperwork Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . I 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 /> IpC 0 ( Title : <br /> Name : S - <br /> Date : Z O <br /> Signature : <br /> RECEIVED <br /> J U N 01 2020 <br /> L NNe' IRON [N ] ENI1lsAL IILAII <br /> 1 ) Ll)AR NIENT <br /> 1868 E . Hazelton Avenue Stockton , California 952051 T 209 468-3420 1 F 209 464-0138 1 www. sjcehd . com <br />