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06/ 22 /00 12 : 04AM HPFAX Page 2 <br /> Environmental Health Department <br /> el <br /> Al <br /> t ) Jl I 'i vrIpft <br /> . ... 3 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any YANQ$ violations noted in the " Notice to Comply" in the alfached Inspection Report must be correct gd Within 30 days of <br /> receipt of this Inspection. This certification form must be submitted to the Environmental Health Department (EHD) address E <br /> at the top of this form within 3o days of rece€pt of the Inspection Report, HSC 25404.1 ,2(c)( 1) i <br /> Al! resections to o httrr y1olations rioted 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 Mdbin 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 willbe <br /> billed at the current hourly rate. <br /> It t <br /> For this certification to be coinplete , 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 resultslmanifestsltraining records/other appropriate paperwork, andlor photos verifying <br /> corrections <br /> Operator's certification <br /> inspection Date : March 04, 2019 Inspected By: CLAUDIA MURQ <br /> Facility Address : 2222 E HAMMER LN , STOCKTON GBRS 10 . IIIIIIIN 10182941 <br /> 1 certify under penalty of law that: <br /> 1 . I have corrected the vialafions specified in the Inspection Report frorn the above.-mentioned inspection date. <br /> 3 <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR FACH VIOLATION <br /> and € believe the €nformation to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent• a <br /> 4. lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (H5C 25191 ) <br /> Name; _ 1 400 1L. .- -- . .._.._ Tiller � d <br /> Signature: pate: <br /> 3 <br /> MAR <br /> 2019 <br /> INN <br /> 186a E4 Hazelton Ay4nue l Stockton, Gallfomia 852051. T . 249 468-3426 ( F 209 d64�0198 1 vww, sjoehd, com <br />