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201270 -20 16:37 VisaMa Sales 15597320817 2094683433 P 1/2 <br /> AV <br /> L <br /> }� <br /> f sV s <br /> SAN JOAQUIN COUWfY <br /> I=NVIRONMENTAL HEALTH Dl~PARTMENT ��� Q ��� <br /> 600 East Main Street,Stockton,CA 96202-3029 <br /> Telephone:(209)466.3420 Fax:(209)468.3433 Web:www.siapv. /ehd rF �'' <br /> �Lav° ,I,t <br /> tin <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30 j&s of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(P-HD)address at the top of this(form within 30 days of receipt of the <br /> 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 <br /> disputes to any violations,are to be submitted using this certification and returned to EHD yt010 30 days <br /> unless otherwise specified in the Inspection Report, HSC 25185(c)(3) <br /> Note: All EHD staff time associated with falling 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 results/manifests/training recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: 3/20/2022 Inspected sy:Stacy Rivera <br /> Facility Address: 2502 W. Charter way EPA iD#: CC.L00028955z <br /> i certify under penalty of law that: <br /> 1, i have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate,and complete: <br /> Photos„_„_Paperwork X =Statement <br /> 3. i am authorized to submit this certification on behalf of the Respondent. <br /> 4. i am aware that there are significant penalties for submitting false information,including the <br /> possibility of a tine arWVor imprisonment for known violations. (HSC 25191) <br /> Name: Mike Eliaasson Title: Cardlock Manager <br /> Signal Coate: 4/20/2012 <br /> EHo22 -MRwOW1r <br />