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SAM �� Environmental Health Department IC QU N T RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the'Notice to Comply" in the attached inspection Report musk be corrected within 30 days of receipt of this inspection. This certification form must be submitted to the Envirnnrnental HeaRh Department (EHD)address at the bottom of this form within 50 days of receipt of the Inspection Report, HSC 2-5404,1.2(c)(1) All oarractions to other vlolations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any Violations, are to be submitted using this certlflcation and returned to EHD wlthln 30 days unless otherwise specified in the Inspection Report. HSC 25185(c)( ) {Mote: All EHO staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete, the operator of the site must include: Astatement documenting what corrective actions were taken or will be taken for each violation Copies of sample resuItsfmanirests/training recordslother appropriate paperwork, andlor photos verifying corrections Operator's certification Inspection Date: September 16, 2020 Inspected By: ROBERT LOPEZ Facility Address: 3122 Brookside Rd, Stockton CERS ID: 10142589 certify under penalty of IErW that: i. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection data. 2. 1 have persanslly examined the fallowing documentation submitted as proof of compliance FOR EACH VIOLATION aDd i believe the information to be true, accurate, and complete: Photos Paperwork_P',j.,Staternent 3. 1 am authorized to submit this certification on behalf of the Respondent- 4. 1 am aware that there are significant penalties for submitting false information. including the possibility of a fine andh imprisonment for known violallons. (HSC 25191) AniqIIS t]W&rd0fErWIrunmernai['., Mame: Title: Signature: Date: �1�' I 1 a