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Si1 IN j 0 A u ( N1 � l1E� i �•+r'� � C�� � h�l �c. l �=2 �� �� 1 •� e6 � e � �ll' �:od� �� •� <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 . <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 : October 25 , 2018 Inspected By : TRICIA DAI <br /> Facility Address : 1247 S WILSON WAY , STOCKTON CERS ID : 10181543 <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 ✓omPaperwork 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 . ( HSC 25191 ) �] <br /> Name : <br /> Y " 1Jn6?, . ! " t- ALX1POn Title : iY��j r 07L P, d, <br /> Signatu (rLn-:' �/ i f 4AAXZc k ` Date : I Z S— I <br /> MARK HERNANDEZ <br /> TRANSPORTATION SUPERVISOR <br /> RECYCLE COORDINATOR <br /> r <br /> The Salvation Army Stockton ARC <br /> 1247 S . Wilson Way <br /> DOING Stockton , CA 95205 <br /> THE MOST P : 209 .466 . 3871 ext . 228 <br /> GOOD F : 209 . 466 . 9347 <br /> www. salvationarmy. org E : mark.hernandez@usw.salvationarmyorg <br /> 1868 E Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 1 F 209 464 -0138 1 www. sjcehd . com <br />