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SAN JOAQUIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Mir MINOR volations noted in rie *otce to Comply' in the =etched Inspection Reeort n4t>at be corrected within 37 dErs of <br /> receipt of tKs inspecfm, This wifjmon fr-mt rr%w to submitted to the Envfm?wcital F,calth DCpurtirrp+nt fCHD) addresv <br /> at the too of thus far, : within 30 days of receipt of tgEe Inspectia-, Repast HSC 2540A 1 -2(c3t1 ) <br /> All r;Ttttxiicxas �a4,tii,ns noted In the atWied impec(pon Report (14) or Cor !"nu.Mon Farm, or diswes to any <br /> vviatiom , arc to bo submitted using thuG cert liWt�on and retUfneo to EHD witnon Sift dart unrolls cthe ,r%e ip*cife•d In to <br /> it ipn rtepvrt. I *U 751185(C)P) <br /> Nato: 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 opermtor of the era rrcw utc de: <br /> A statsman! doeufrwntotp votwui wroiAvc achQr* wvru taxcri or ural tll taken Idr titch *a�al•0 <br /> Cap+ at sample resuf'srnu�sifestshdir' +q wowdx'o(her srptxcxrote jo mark, and/or phu:�. ve,hying <br /> :fxrsie;ion4 <br /> - 4por:or's cartiFr"slidr� <br /> Inspection Date : tuiar�h 26 . 2019 Inspected ay_ ZUM BA ""lI %I = <br /> Facility Address : 800 c+ CHERL•KEE LN - LOO ! CERS ID: 1011815^ r <br /> r��*!ify r�'ir:r fm-r�y nt �s.v thst : � <br /> I <br /> S - I hsdpe _-•ormaed tree vidaticrz specmod in the Inspeton Rcport from the above mentiotied �:pWnn date, <br /> 24 t ha',v personalty exarnlned me (40nowing docu nentaton submMed as pt-cc ofco�liance FOR EACH Viii s i 104 <br /> ;,nrl I t:eltrve I'm etirxnrvIdn to be true, accurate , and cdfnplote !k <br /> Pt who. Pumvnjrk _s'otarr*nl <br /> 3, I aft aulhorixod tv ;vtittmil Ir"i ixo iivilavi on rthn•'t of t?fi' RM. pondem <br /> 4 . I am aw4ve :hat mare are cignsficarr peraltio5 far aut)nutt rip fast inYxmotion, Irx;tudwV the pa!egl%lity at a tine <br /> and/or irnpmonmment for known violations- (HSC 25591 ) <br /> Name. PT ft <br /> SigndtUrir: L - - I7F3tE: •_ Q 1 `i C A - rc`i <br /> - i <br /> i <br /> I <br />