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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 952056232 <br /> Telephone:(209)468-342.0 Fax: (2.09)468-3433 Weh:www.sigov.orn/ehcl <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any 1v11NOR violations noted iri the "Notice to Comply"in the attached Inspection Report rraust be corrected within 3030 clays of <br /> receipt of this inspection. This certification farm 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(e)(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 da-§ 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 bo <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 recordslother appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: November 08, 2018 Inspected By: John Alaniz <br /> Facility Address: 1120 W CHARTER WAY CERS ID: 10182443 <br /> 1 certify under penalty of law that: <br /> 1 1 have corrected the violations specified in the inspPrtlan Report from the shove-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EAC11 VIOLA'FION <br /> and I believe the information to be true, accurate, and completo: <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 /> andlor imprisonment for known violations. (HSC 25,191) <br /> Name: 2 iC lTitle (urs <br /> • Fl kk c <br /> Signature:f f' Date: L - 30 1 `1 <br />