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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 95205-6232 Telephone : <br /> (209) 468-3420 Fax. (209) 468 -3433 Web: wwvr. sLgov_ orcg/ehd <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 <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 (I R) 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 /> For this certification to be complete , the operatorof 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 recordstother appropriate paperwork , and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date : August 27 , 2019 Inspected By : Christine Lawrence <br /> Facility Address : 14063 E COMSTOCK CERS ID : 10186183 <br /> [ certify under penalty of law that: <br /> 1 . 1 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 <br /> VIOLATION and I believe the information to be true , accurate , a d 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 possibility of a fine <br /> and/or imprisonment for known violations . (HSC 2 191 ) <br /> Name : CWA a { � r Title : �ca-V - <br /> Signatur Date: V <br /> G.. v i Gt. a <br /> N2 jolr&C� ca` 670 i c. e ?0t 10Cal CC <br /> led 6� la2 0=24 0 a 41 ), <br /> Gam / cP 5 Id X0 Ile7for; <br /> � � a iso ,ce. .." ��icQ & I <br /> Z ' d Z099- 1. 06 60Z ' oul ' aelM WR' j `20 1, 161. 6Z AoN <br />