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i <br /> I <br /> I <br /> I <br /> Environmental Health Department <br /> SWJDAWN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> I <br /> Any M1N0R violations noted in the"Notice to Comply' in the attached Inspee#ion Deport must be correpte within 30 d go of s <br /> receipt of this inspection_ This certification torn must be suk)mlffed to the Enviror}mentaf Hsaffh Depeftent(EHO) address at <br /> the bottom of this form within 30 days of receipt of the Inspection Deport. 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 certlficetlion and returned to EHD with In..30 days unless otherwlse specified in the <br /> Inspection Report. HSC 25155(c)(3) <br /> Note: All EH staff time associated with falling to comply by the above noted dates will be <br /> billed at the current hourly ratia. <br /> For this certification to be complete, the operator of the site must Include: <br /> A statement documenting what oorrective actions were taken or will be tElken for each violation . <br /> Copies of sam pie results/rnanifesUhraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: September 01, 2020 Inspected By: ROBERT LOPE <br /> Facility Address: 3601 Pacific Ave, Stockton DER 10: 10145583 <br /> 1 certify under penally 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 fallowing documentation submitted as goof of compliance FDR EACH VIOLATION <br /> and I believe the information to be true, accurala, and complete: <br /> Photos Paperwork�LaLement <br /> 3. I am authorized to submit this certiic;Eition on behalf of the Respondent_ <br /> 4. 1 am aware that there are significant pen allies for submitting false inforrrialion, including the possibility of a fine andA <br /> imprisonment for known violations,-(HSC 25191) <br /> Name: """" "aa+ +"�"" .�co�, r.r ` Title: <br /> Signature: Data: <br />