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S A J O N I Environmental Health Department <br /> COUNTY- <br /> RETURN N T COMPLIANCE CERTIFICATION <br /> +any MfNOR violations noted in tfie Noffce(o Compir in the at(ached fnspedion Report mus(be carr ed MMof <br /> receipt of this Inspection, This certificatlon loan must be submitted to the Envlronrnental Health Deparlment (EH D) address at <br /> the holtom of this form within 30 days of receipt of the Inspection Report. HSC 25404.9,2(c)(9) <br /> All corrections to otheryiodat ons noted in the attached Inspection Report(l R)-or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification acrd returned to EH WAhin W days unless otherwise specified in the <br /> Inspection deport. HSC 25185(c)(3) <br /> Note: All EHD staff#ime associated with failing to comply by the above noted dates will be <br /> b(ffed at the current hourly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting what oorrective actions were taken or will be taken for each violation <br /> Caples of sample resultshnanifeststtr2ining recordslother appropriate paperwork. andlor photgs verifying corrections <br /> Operator's certification <br /> Inspect9on Date: September 16, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address: 5023 VV EIGHT MILE RD, STOCKTON CERS ID: 9094,5347 <br /> certify under penalty of law that: <br /> 9. 1 have corTected 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_L1_Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4, t am aware that there are significant penalties for submitting false irkformation, including the possibility of a fine andlt <br /> imprisonment for known violations. (HSC 25199) <br /> Mrf�Md aMprdo�Enva�vn�nlrl�ollrp�lce <br /> Name- Title. <br /> ignaturae� _ Bate: � �� <br />