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i <br /> " I <br /> Environmental Health Department <br /> SANJOAQUIN <br /> .n> <br /> CQ U 1qTY' <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report mus[be corrected_Wmthin 30 days,of <br /> receipt of this inspection. This certification form must be submitted lo tho Environmental health Department (EHD) address m <br /> the bottom of this form within 34 days of receipt of the Inspection Deport. HSC 25444.9.2(c)(1) <br /> All corrections to oilier violations noted in the attached Inspection Report (1R)or Continuatlon Form, or disputes to any <br /> violations, are to be 4uhmifted using this certification and returned to EHf3 wither Liniess otherwise specified in the <br /> Inspection Report. HSG 25185(c)(3) <br /> Note: All EHb staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this rtlfl ation to be Complete, the o rabratheskemustir kde: <br /> A statem ent documenting what corrective actlohs were taken or%(III be take n for each violation <br /> Copies of sam pie res ultsfmanifestsAraining recordslother appropriate paperwork, andfor photos verifying corrections <br /> Operators certification <br /> Inspection Date: September 16, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address: 735 Wilshire Ave, Stockton CER ID: 10144743 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the viIolations 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 FOIA EACH MOILAT10N <br /> and I believe the information to be true, accurate, and complete; <br /> Photos_____Paperwork—k—S tatement <br /> 3. 1 am euthorized to submit this certification on behalf of the Respondent_ <br /> 4_ lam award that there are significant penalties for submitting false information, including the{passibility of a fine andh <br /> imprisonment for known violiations. (HSC 25191) <br /> AmwW <br /> Name. Title: <br /> Signature: Date: �� <br />