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V E D San Joaquin County JUL S 1 2020 Environmental Health Department 1868 East Hazelton Avenue , Stockton , California 95205 -6232 Telephone: (209 ) 468-3420 Fax : (209 ) 468-3433 Web: www. sigowora/ehd,kizINIVINUNMENTAL HEALTH RETURN TO COMPLIANCE CERTIFICATIONIPAITMFNT Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address at the top of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 1 . 2 (c) ( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report. HSC 25185 (c) (3 ) Notes All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete , the operator of the site must include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections Operator's certification Inspection Date : September 23 , 2019 Inspected By : Shewit Woldearegay Facility Address : 2375 N TRACY BLVD CERS ID : 10182109 I certify under penalty of law that: I 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true , accurate , and complete: Photos V/,aPaperwork Statement 3 . 1 am authorized to submit this certification on behalf of the Respondent. 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or imprisonment for known violations . ( HSC 25191 ) Name : a Swar 1g119S3Cn Title: i Signature: Date: JLIL 31 2020 ENVIRONMENTAL HEALTH PERMIT/ SERVICES