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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: (2D9) 468 -3433 Web: www_sigov.org/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 (1R) 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 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, andlor photos verifying <br /> corrections <br /> Operators certification <br /> Inspection Date : August 27 , 2019 Inspected By: Christine Lawrence <br /> Facility Address : 14063 E COMSTOCK CERS ID : 10186183 <br /> I certify under penalty of law that : <br /> 1 . I 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 /> 11 <br /> Name : a( � Y Title : <br /> Signatur Date : <br /> A � 4#t0,P / Pc* <br /> La 646� Ic L r ?!T i 11 /c^ clCt <br /> G400&0 C�7 <br /> p <br /> v D <br /> ��f syr 40 /1 & cel <br /> AW (P ys <br /> z9 Z £ 99- 1, 06 60Z ' oul ' aall ! IN b RSI d90 : E0 61, ZO oe4 <br />