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l <br /> Environmental Health Department <br /> SAN . IOAQUIN <br /> { COUNTY - <br /> � <br /> Greatness grows here . <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 ( 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 . 1 <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 , and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date : September 10 , 2018 Inspected By : ZUNA BARKER <br /> Facility Address . 2375 N TRACY BLVD , TRACY CERS ID : 10182109 <br /> I 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 VIOLATION <br /> and I believe the information to be true, accurate , and complete : <br /> Photos Paperwork Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 1 <br /> 4. 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine 1 <br /> and/or imprisonment for known violations . (HSC 25191 ) <br /> Name : }� r��4r� qm MfSSDN. Title : RAt S18ell / I <br /> Signature :, �. Date : 10 <br /> 1868 E. Hazelton Avenue i Stockton , California 95205 1 T 209 468-3420 i F 209464-0138 1 www.sjcehd .com <br />