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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-623 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.s*gov.org/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />ENVIRON?, <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected Q ffm-f -3,0 days of, <br />receipt of this inspection. This certification form 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(c)(1) <br />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or dispute I 'ED <br />violations are to be submitted usingthis certification and returned to EHD within 30 days unless otherwise s eP1r1tFmCe <br />v p <br />Inspection Report. HSC 25185(c)(3) JUN 22 201 <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 />ENVIRONMENTAL HEALTH <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 <br />corrections <br />Inspection Date: June 09, 2017 Inspected By: <br />JOHN ALANIZ <br />Facility Address: 1580 W MAIN ST, RIPON CERS ID: 10180643 <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 />DEPARTMENT <br />2. 1 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: (Z (, 6-i .. h rwTitle:' limeC To iL OF &y,*rul;j / C-,Q-rA%.. Ai: <br />Signature:02�YL(25�Date: to 13 l <br />4V -AA- Vl� eT &0\'� Cr� 1� (L I 1 1:1 1 <br />Tl0-T t�a� <br />6Iz��� <br />