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SAN JOAQUIN <br /> Environmental Health Departmenwk <br /> t C10, + Y ' <br /> r RETURN TO COMPLIANCE CERTIFICATION <br /> o try 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 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 /> I <br /> Inspection Date : January 29 , 2019 inspected By : ZUNA BARKER <br /> Facility Address : 341 E MAIN ST , RIPON � CERS ID : 10181381 <br /> I certify under penalty of law that: I <br /> I <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 nrpliance FOR EACH VIOLATION <br /> I and I believe the information to be true , accurate , and complete : 544 'c vv 0- * S &' D <br /> � �.- sem 4 <br /> `Turmo <br /> Photos ✓ Paperwork Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent . <br /> I � 4 . I 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 /> flN � c..c <br /> Name : �- T� Title : <br /> Signat Date : Iof a <br /> i <br /> L -- I <br /> ; E ' Y t ! <br /> Le <br /> 8 20P9 <br /> - NVIRONMENTAL HEALTH <br /> t' FR " IT/SFRVI ^ ES <br /> LM <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 458- 3420 ( F 209 4614, 138 I www. sjcehd . cum <br /> r <br />