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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />IMM411MR111MIA 0,MMIL01111111111011 I let 1#1 <br />I• <br />i -ju�, <br />All corrggtions tg oth@[ yiolatigLis noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />T.0 <br />Inspection Report, HSC 25185(c)(3) <br />UNIT= 111 M :1 is * 1# t 0 <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: Janua!y 29, 2018 inspected BY: ELIANNA FLORIDO <br />Facility Address: 6633 PACIFIC AVE, STOCKTON CERS ID: 10594654 <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <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 />PU Photos Paperwork 04"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: a v%V I 141,tA 01;L Title: <br />