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SRN- JOARIN Environmentat Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any Ml mlations wWd in khe VULm W Cor 15e inthe atlachmd InwpWon Report Must ba {diad within 3P clave <br /> reo*t of Ihis n*0dibr.-This cartllication form musk tM auhmltletl to the Frulrorrrrwnlal Haallh DwA.Lb t(EHG)address ei <br /> the t eMrt 91MIR form wthin 304V-t of rertlpt of the lnapeo7lon Reporl. HSG25441.1ZcX1) <br /> A➢enrre=M io aMX videtians rrptCtl Bt the atlachoii Inapetiion Repan(IR1 or Geetimustion Form,o•*Wup m to any <br /> violatiorw.ASF 19 44*Lhrreftad kisrQ this OBrtika6w Prd aP vNL*d to EHO tftWLAQjh=pnlaas otherwism spxifietl in We <br /> InepeHIm Repa1. HSC 75145(q(31 <br /> NOW All EHU atoff lima associated with filling to comply by the a boye noted Bates wl I I b0 <br /> billed at the eurrent hourly rata. <br /> Fa r th is certification to be=rnpl ete, the cperalor or the sde must nrwudo: <br /> A slatamerrtdxwnaMing whM aorreellve actions were Won or will be Fahr:,Ter each viknl ion <br /> Copia Of wVa tesult&&nam fes %training rµcardhpbkhor spprtoate ps"rwork,ariwor phuioa ve ifying QwmrWv% <br /> opersors cerffirA tion <br /> Inspectlon Date: May 24,2019 InspnUd By: ELIANNA rL01100 <br /> Facl Ilty Address: 24X McHkwry Ave,Escalon CERS IU' 10504351 <br /> I oeIry oMer penalty of lair that: <br /> 1. I havg arrgdod pts vlalallome sMoifed In pie Irspoctiom Repot rfpfoth4 gheva-nianilered Irkapselion data. <br /> 2. 1 nava pally exarnlned the rdlowiny douunwritalW submiftd as proof ad oonmanca FDR EACH VKkATIDN and <br /> I t:eliave the infonvielJon to be true,Krurwla,emseamplela: /} <br /> Ph471476 � PYp8rW8rk F 9r8lt�flLgr <br /> 3. 1 wr aJtha129d to submit thea carIlrcadmn Ort b*U f 8r the 19a'J wdartl. <br /> 4 1 ern awbl9 tlwt alera are*,rPi t:arA Por10410 for strgmitllnp Ndw Irderriwdam,including the p=aUlky df a fire ardlw <br /> Imprisonmeatfor blownviAtkb s. (HSC25191) <br /> Name. Trtle: <br /> $Ignattlre ♦Tabs, <br /> t&69 E HeaellanhvuwrF l S1atl ten,Calromis 9fi2�51 T M?468-34701 F 209464-0174 1 wwwsloah;1 v7rn <br /> July 25,2019 pg.3 <br />