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SAN J D A Q U I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address at <br /> the bottom 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 disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 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 will be billed <br /> 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 records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: November 25, 2019 Inspected By: LYDIA BAKER <br /> Facility Address: 666 E HARDAWAY RD, STOCKTON CERS ID: 10183481 <br /> 1 certify under penalty of law that: <br /> 1 1 have corrected the violations speoafied 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 /> 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 possibd ty of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: Z"17� sCTA -1�={Z�ti Title: Ow4uNzf <br /> Signature: Date: �Z- 2-3ZI <br />