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S I� Environmental Health Department <br /> COUNTY-- <br /> RETURN <br /> UNT 1 '.F ETUF N T MPLI NCE CERTIFICATION <br /> Any MINOR vlolations noted in the"Notice to Comply' in the attached Inspection Report must be corrected within of <br /> receipt of this Inspection, This certification form must be submitted to the Frnrironmantal Health Department (EHD) address at <br /> the botlom of this form within 30 days of receipt of the Inspedion Report. HSC 2-5404,1.2(c)(I) <br /> All corrections to other violations noted in the attached Inspection Report(IR) or Continuation f=orm, or disputes to any <br /> violations, are to be submitted using this certification and returned to E H D withln 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 abovo noted dates will be <br /> bllled 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 he taken for each►ablation <br /> Copies of sample results lrnanlfesfsAraining rscor&dather appropriate paperwork,andlor photos verifying corrections <br /> Operator's certJification <br /> Inspection Date: S epternber 01, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address: 3535 N EL DORADO ST, STOCKTON CERS ID, 10595476 <br /> I certify under penalty of law that: <br /> 'I. 1 have corrected the violations speclfled in the Inspection Report from the above-mentioned inspection date. <br /> 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 oomplete- <br /> All <br /> Photos�Paperwork Statement <br /> 3. i am authorized to submit this certification on behalf of the Respondent_ <br /> 4_ I am aware that there are significant penalties for submitting false information, including the possibility of a fine andh <br /> imprisonment for known violations. (HSC L51,91) <br /> Armored Va1gad0rc11AF0n16WTW <br /> acme= Title: <br /> Signature: Date: r <br />