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®%19 - 06 - 13 13 : 54 ENGINEERING 2098253893 > > P 1 / 6 <br /> ■ <br /> ■® N : U Environmental Health Department <br /> 1 . <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 daVS of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address <br /> at the bottom of this form within 30 days of receipt of the Inspection Report , NSC 2. 5404 , 1 , 2 (e)( 1 ) <br /> All r�Q�rgctipns 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 corrections <br /> Operator's certification <br /> Inspection Date : June 06 , 2019 Inspected By : ZUNA BARKER <br /> Facility Address : 1777 W YOSEN41TE AVE , MANTECA CERS ID : 10181559 <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 /> Photos Paperwork ''40 Statement <br /> 3 . I am authorized to submit this certification on behalf of the Respondent , <br /> 4 . 1 am aware than there are significant penalties for submitting false information , including the possibility of a fine and/or <br /> I <br /> mprisonment for known violations . ( HSC 25191 ) <br /> Name : 47t� Wkt 00�6 t Vr44 Title : ���. -g� % <br /> Signatures--, r "�is � ` ° , - �- Date : 13a <br /> 0 L t v r l — .. " ar° <br /> JUN 13 2019 2"', <br /> ENVIRONRIENTAL HEAL7NH <br /> DEl"AI OIEN "T <br /> 1868 E . Hazelton Avenue i Stockton , California 962061 T 209 468 -34201 F 209 464 -0138 1 www . sjeehd , corrt <br /> Received Time Jun , 13 , 2019 1 : 48PM No . 5150 <br />