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Oct 151912 : 22p Zoom Car Wash 209-957-3428 p . 1 ` <br /> i ! <br /> San Joaquin County <br /> i Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www. sigov. orglehd <br /> i <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any; INOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 da s o <br /> receipt of this inspection , This certification form must be submitted to the Environmental Health Department (END) 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 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 : <br /> billed at the current hourly rate . <br /> Far 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 /> Operator's certification <br /> Inspection Date : June 04, 2019 Inspected By : John Alania <br /> Facility Address : 4661 QUAIL LAKES DRCERS ID : 10186921 <br /> I certify under penalty of law that: � t <br /> 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date , <br /> i` <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 /> 34 t am authorized to submit this certification on behalf of the Respondent. <br /> 4v 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: , bQ t_ .o -r � . Title: <br /> Signature . /—� .L�( f ' ;' Date: <br />