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SAN JOAKIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations not in the'Notice to Comply"in the attached Inspcction Report must be cprrecied within 313 days of <br /> receipt of this inspection. This ccrtiricatinn farm must be submitted to the Environmental Health[Department(EHO)address at <br /> the bottom of this farm within 30 days of receipt of the Inspection Report. HSC 4404.1.2(c)(1) <br /> All Mrrectiqngi tQ 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 END wit i 0 gays unless Otherwise specified in the <br /> InSpeclror5 Report. HSC 25185(c)(3) <br /> Note: All EHID 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 corn plete, the operator of the site must include: <br /> A statement documenting what corrective actions were takon or will be taken for each violation <br /> Copies of sample resultsJmanifestsllraining recordsfother appropriate paperwork,andror photos verifying corrections <br /> Operator's certification <br /> Inspectlon Data; May 06,_2019 Inspected By: EL)ANNA FLOR100 <br /> Facility Address: 3728 E HAMMER LN, STOCKTON CERS ID: 10406332 <br /> 1 certify under penalty of law that, <br /> 1. 1 have corrected the violations specified in thn Inspection Report from the abeve-mantidnad inspection date. <br /> 2. 1 have personally examined the following documentation submitled as proof of compliance FOR EACH VIOLATION and <br /> I believe the information to ho true,accurate•and complete: <br /> V 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 pen allies for sulornk ing False information,including the passibility of a fine andlor <br /> Imprisonment for known violationlIs.. (HSC 25191) <br /> Name: e �1TRW NA( � <br /> Signature; ADate: 1 <br /> 1868 E.Hazelton Aventm I Stockton.Califomia 95205 1 T 209 468.3420 I F 209 484-0438 1 www.slooM.com <br /> June 25,2019 pg.3 <br />