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Environmental Health Department <br /> $� <br /> SAN <br /> sJOAQUIN <br /> ^ 1I _ -- COUNTY — <br /> IF <br /> OUNTY -, Greatness grows hereOW . <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 /> i <br /> Inspection Date : July 01 , 2019 Inspected By . JASON GAITAN <br /> Facility Address : 212 E MAIN ST , RIPON CERS ID : 10182359 <br /> I 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 . I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and <br /> 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 and/or <br /> imprisonme or known violations . (HSC 25191 ) <br /> y� <br /> Name : � !il Title : 66LI 4404 <br /> Signature : Date : ?�/ <br /> SII . <br /> RECEIVED <br /> JUL 2 4 2019 <br /> ENVIRONMENTAL HEAL;rH <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 11) 1A4WMf!8NjTwww .sjcehd .com <br />