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r <br /> Environmental Health Department <br /> SANJOAQUIN <br /> C C)U lel T - . . <br /> f ETURN TO COMPLIANCE CERTfFfCATION <br /> AnyNNO violations noted irk the "Notice to Carnply' in the attached Inspection Report must be corrects within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Deparlment (E 1-11113) address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HGC 25404.1.2(c){1} <br /> All corrections to other violatlons noted in the attached Inspection Report (A) or Continuation f=orm, or disputes to any <br /> violations, are to be submittecl using this co rti ricatio n and return ad to EHD With'n 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 uperatnr of the site must include; <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sarripte resukshnan fesWtranmrg r ref other appropdate papenvork, armYor pthotos ve*rrg og'md cos <br /> Operator's certification <br /> Inspection bate: September 01, 2020 Inspected By: ROBERT LOPE <br /> Facility Address: 530 W AGAC IA S T, STO KTON DERS 1D: 10142913 <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 cnmplience FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complafe: <br /> `Photos____paperwork—K—Statement <br /> 1. J am authorized to submit this certification Dn behalf of the Respondent. <br /> 4, I am aware that them are significant perial ties for submitting false information, including tha possibility of a fine andh <br /> imprisonment for known violations. (HSC 25991) <br /> Name: "^^u OW"OWM Title- <br /> Signature: Date: <br />