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i ANJOAQUI Environmental Health Department COU NTY, RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected within 30 dgy of receipt of this inspection. This certification form must be submitted to the Emironmental Health Department (EHD)address at the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any V10lations, are to be submitted using this certification and returned to EHD within 30 days unless otherwlse specTed in the JnspeotionReport. HSO251d5(c)( ) Note: All EHD staff time associated with falling 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: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample res uIWrnanifesfsltraining recordslother appropriate paperwork, and/or photos verifying corrections Operator's certification Inspection Date: September 16, 2020 Inspected By: ROBERT LOPE Facility Address: 1200 W Hammer Ln, Stockton CERS ID; 10143519 certify under penally of law that: 1. l have corrected the violations spec•ffied in the Inspection Report frorn the above-mentioned inspection data. 2. 1 have personally examined the following docurnentatlon submitted as proof of compliance FOR EACH VIOLATION and I believe the information to he true, accurate, and complete; photos Paperwwk�klaternent 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 arid/ imprisonment for known violations. (HSC 2519'1) 4 1,sena D041da1EmArG Name; Title: Signature: Date; i I