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SAN._.,,.J0AQU1N <br /> Environmental Healt <br /> h Department <br /> ,o�n,j MINO,g RETURN To COMPLIANCE CERTIFICATION <br /> v'01,4tions noted in the"Notice to(-Otnply. <br /> receipt Of this ins ted This <br /> at the top of this certification fon' in the attached -i P <br /> 11 MW be Subtnitted to the Environmental <br /> of receipt virorn, n He <br /> form withill 30 claYs Inspection Pepor I t nspec �GPart must be corrected <br /> Of th,�,.I rl' L21�Llhln 30 ds Ls of <br /> Corrections to otj HSG 25,404.1 apartment(EHD)address <br /> All tai alth D <br /> ier Violations noted in the attached In-pection <br /> Inspection violation-,, are.to be-submitted using this , I R)01'Continuation Form,or disputes <br /> Report(I <br /> Inspection Report. HSC 2518s(c)(3) certification and returned to"HD within 30 d1`1 unless otherwilsputes to any <br /> E"sPGcified in the <br /> Note: All rz"D staff time associated with falling to,comply by the above noted dates%V1II 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 dOCurnenting what corrective actions were takers Or will be taken for each Violation <br /> (_'opies of sample I-egultsl;tllallifests/trainilig 1'000rds/other appropriate paperwork, - <br /> corrections rk,and/or photos verifying <br /> Operator's Certification <br /> Inspection Date: Septembeir 14, :2018 Inspected By: KASHIF ALI <br /> Facility Address: 710 E YOSEMITE AVE, MANTECA CERS ID: 10184267 <br /> 'tify under perisity of law that: <br /> 1, I have corrected the violations specified in the Inspection Report from the above-mentioned Inspection date. <br /> I have personally examined the following documentation si.ibmitted as proof of compliance FOR EACH VIOLATION <br /> and J believe the information to be true, accurate,and complete: <br /> -Photos__P@porwork Statement <br /> S. 1 am authorized to submit this certification on behalf of the Rospondert. <br /> 4- 1 am aware that there are significant penalties for-,ut)rnitting false information,iriciuding the possibility of a fine <br /> and/or impri rinient for k wn violations. (HSC 25191) <br /> Name,- k'!3Lk,-z Jitle, <br /> Date: <br /> Signature.-- - ! E - <br /> L) <br /> D <br /> 9,5205 1 T 209 468�3420 1 1: (iq 464-0-138 <br /> up <br /> 1868 El Hglzen Av�p,,n ltr Stockton, California <br /> i <br />