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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 95205-6232 CEI <br /> Telephone: (209 ) 468 -3420 Fax : (209 ) 468-3433 Web: www. sogov . org/ehd � a <br /> RETURN TO COMPLIANCE CERTIFICATIONAR 19 2019 <br /> Any 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 taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying <br /> corrections <br /> Inspection Date : February 14 , 2019 Inspected By : STACY RIVERA <br /> Facility Address : 4800 S AIRPORT WAY , STOCKTON CERS ID : 10181439 <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 compliance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate , and complete : <br /> Y� <br /> Photos Paperwork Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 1 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 ) /J �-� <br /> Name : � � � �S " / � � -� (� Title: 0 �Cr0.oar'i e � <br /> Signature : ,� Date : <br /> �Y. kem lD3 CJr rec' �PL lil ✓l [ crlC iuL res po . . S , in 4 . IV Y' br din SftLhi Y1PlX , 1140 <br /> C Ce rS '�) p <br /> IDL � Z> rr94�6L - Fe5 � DASPLa \ aviS SUt , n't , 4 eJ I En --� v <br /> �2 en 8 1 �L e MD , . L r i Z, N LG[ ✓1 . / -h n (I Ll a � � Q n SD 6 �5; CA �2 <br /> � ho �av� ccs SSP �- Ke, �GY <br /> bJ � � <br />