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n <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, Cartfornia 95205-6232 <br />Telephom. (209) 468-3420 Fax: (209) 46"433 Web: wwwsj9ov-E&&hd'0W1'1_� 0 <br />'4 <br />r:ce <br />Ali correction1l to qtgr violatio 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 EHI) within 30 days unless otherwise specified in the <br />Inspection Report HSC 25185(c)(3) <br />Note: All EHD staff time associatedwith 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 resuits/manifestsftraining recordsfother appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certification <br />September 23, 2013 <br />Facility Address: 2072 W YOSEMITE AVE CERS ID: <br />I certify under penalty of law that: <br />Elena Manzo <br />mom <br />I have corrected the violations specified in the Inspection Report from the above-mentioned inspection dale. <br />L I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />and 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. lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/orinment for known violations. (HSC 25191 <br />Name: <br />Signature: -_Z <br />r <br />T1ft_f-)_4"V e- <br />-Date: 7 - 4 / <br />A <br />6'd OOL9VZe60Z dogs �oinb deo: 60 L I, 90 lnr <br />