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Environmental Health Department <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 /> the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 1 .2(c)(1 ) <br /> All corrections to other violations rioted 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 30vs unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> (Vote : All EHD staff time associated with tailing 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/manifestsAraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: July 26, 2619 Inspected By: PAUL NSO <br /> Facility Address: 655 W CLAY ST, STOCKTON CERS ID : 10181319 <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 /> 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. (HSC25191 ) p � <br /> Names ' t1 4<< vcc Title: L.-e4) u1 '10A) ol el?)�4 If "Nrvr1 CV <br /> Signature: ? Date: ( �l <br /> 1868 E. Hazelton Avenue 1 Stockton , California 95205 1 T 209 468-3420 1 F 209 464.0138 1 www,sjcehd.com <br />