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San Joaquin County <br /> Er`,v r(>illlenkal Hea10ti aepsAmErd <br /> IMS East H-ae,tor.Avenue,Slocklon.CsMamia 20D-0232 <br /> refephone-4'D2}453-3420 Fax:(21)9}468-3433 mctib:Lvwy sinov nrnlwhrl <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN -,-VL lure*nuled h u-e'NodD--La Comolf 1-1f:3 itsched Ins Gctan Rrpnrt rnu;.t Gr cnrmrff .wMin 3C•d*V3 W <br /> r� :' of;h s-nspamion. 7hia;brG 1WW,n Inrrr muss Ce�_Lmlltec to Vie EmAranmerrml rlaallh dapartmm fEHD1 add.mm <br /> al 1:1-Iry of mie fu•rr wibin 37 daysadreceiptoftho In5pubcn Report, I I$C 26t-Dd.'.2(c�{iJ <br /> All corrU ianx 10 ether violation4 rl;2Wd 0 U*$Cathed Inap----aP::n Report(IR;or Canthuidion=arnr.ar cic.PLItea to any <br /> vrda'ianr}.sreta be sub!nh-.ed usire,t<iS oer1irx�4Liuu r,nd ret'mmA to EH.0 y the ML4=ag unle9a cthervilae arearfled in tie <br /> lnsp$olion Reporl. HSC 26165(01 31 <br /> Note: Alr EHO staff tinm2 associated wlth falling to lcomply by the above noted dates will be <br /> billed at the curt'erit 11 oil rly raze. <br /> For this certification to he complete, 1heole-agar a€than:emusri.16-, : <br /> A sLknr-•:cacumeril:62; mok carf6divs scl.ons ware rsken c;will bs taxon for each violation <br /> Caples 2f asmple result0-nsnftsls11r;�i1!r9 ngtxxr!pao;i"oppiuprinle papfrwmrk,savor phates Uarllyirrp <br /> Inspectlon Date; April 08,2019 Inspocted By: ELkANN.4 Ft ORldp <br /> 1=acllity Address; 678 N 4-ULSON WAY. STOCKTON CERS ID' 10406311 <br /> !csMIN-jve,pens,ty ar Imethat: <br /> 1_ I rave cnrrea.s�to u o-'etion!5 sprt:find h ihc-.-Inxpttt,r a Refmt'rofn the Wrsre-ment 3rm-�tl Inspearoon dB.PE. <br /> 1 1 iia pa-sonal'y'sxansiiwdthe rC11Uw4• documenWWI9abqllltprlasprooratcornpiiEr,^e"OR EACH VLOLATION <br /> and I bdioMc the rfnnrglion 7a beirus.sacureia,and eorr{Ea e: <br /> ' PhUtcs Paprwork °*,',lwxritnt <br /> I am a flhudi-W Iv stihr d Ibis oF.tlf:csl cn o-r behalf or the Hespa.ent. <br /> 4. I ern avrare that I'rere are sig-;fica-;pcnalt'm far aubrri'Gng false.irrf'xrr_1bun.irWud:rn Ih£poa4.i#y Ufa I re. <br /> sndlcrimprir:�prntirnl W. +7a.vr-ralslons. (HSC 251131r <br /> Namtr;�[, <br /> Signakr�re: Dale; <br /> 'S 1 <br /> May 2, 2019 pg. 3 <br />