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abou <br /> di <br /> Environmental Health Department <br /> Q N s� aQ <br /> , sC0Vi*tTY � ' <br /> G " ro , P1r ? 5 prows lacr �. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> ;Any MINOR violations noted in the "Notice to 0omply" in the aflaGhed Inspection Report must be crarrected within 30 days of <br /> receipt of thia inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404. 1 .2(c)( 1 ) <br /> Ail corrections to other violations noted In the attached inspection Report (IR) or Continuation conn, or disputes to any <br /> violations, are to be submitted using this cartifiration and returned to Ellb within 30 days unless otherwise specified in the <br /> Inspection Report, HSG 25185(0)(3) <br /> Notre : All r=HD staff time assoclated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete , the operatorof the site mustIncludw, <br /> A staternent documenting what oxractive actions were taken or will be taken far each violation <br /> Copies of sample resultshnanifestsrtraining reconis/ofher appropriate paperwork, and/or photos verifying corrRotions <br /> aperator'a coWificetion <br /> Inspection Date: July 31 , 2020 Inspected 13y : ELIANNA FLORIDO <br /> Faellity Address: 541 $ Faolftc Ave, Stockton CERS 1D: 10486180 <br /> I oerfify under penalty of taw that: <br /> 1 . 1 have corrected the violations epeofed in the inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the folkaatng documentation submitted ars proof of oomplianee FOR EACH VIOLATION <br /> and I believe the information to be true, aocurate, and complete: ,r <br /> Photos ,/r Paperwork _ .+` Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. I <br /> 4. 1 am aware that there are slgnlf cant penalties for submitting false information, including the possibility of a fine and/or <br /> Iimprisonment for known violations. (HSC25101 ) <br /> Name:_ jQ"r eI 1 }G.1 � _Tit1e: <br /> EJ <br /> Signature; - <br /> i <br /> I <br /> E <br /> t <br /> I of 3 8/5/2020 2 :2 <br /> i <br />