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i i O Environmental Health Department SWJOAUIN FY- RETURN TO COMPLIANCE CERTIFICATION Argy Jh ) OR vh:4al ons noted in Me "No6ca!o nwJy"in Jhe attached JnspL8Vion R epoyt rnLLvA be corrected within3g dais, of receipt of this inspection. This o9MFication farm must be submitted to the Environmental Health Department (EHD)address at the bottom of this form within 30 days of receipt cf the Inspection Report. HSC 25404.1,2(c)(1) All porrections to other tions noted In the attached Inspection Report(IR) or Continuation Form, or dlsputes to any violations, are to be submitted using this certification and returned to EHD whin 30 dad($unless otherwise specified in the Inspection Report. HSC 2165(c)(3) Note: All EHD staff time associated with failing to comply by the above noted dates will be Bitted at the current hourly rate. For this rtlfl cation to be complete, the operator of the site must include: A statement documenting what correct NO actions were taken or will be taken for each violatior} Copies of sample resultslmani(esMrainIng records/other appropriate paperwork. and/or photos verifying corrections Operator's certfficetion Inspection Date. September 18, 2020 Inspected By: ROBERT LOPE Facility Address: 1549 6 Union St, Stockton 'CERS ID: 10654141 I certify under penalty of law that; 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspeotlon elate. 2. 1 have personally examined the following docurnentation submitted as proof of compliance FOR EACH VIDlAT10N and I believe the information to be true, accurate, and complete: _Photos. Paper+rj�xk CK-'statement & 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 Fina and imprisonment for known violations. (HSC 25191) Name'. Amaro 0W90dWE +Wne0,9 cam, Title: Signature: Date: � �