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San Joaquin County RECEIVED <br /> Environmental Health Department AUG $8 2018 <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orq/ehd <br /> ENVIRONMENTAL <br /> REETURN TO COMPLIANCE CERTIFICATION HEALTH DEPARTMENT <br /> Any MINOR violations no�ed in the Notice to Comply"in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection. This certi ication form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> violations, are to be submitted usin this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)( <br /> Note: All EHD staff time as ociated with failing to comply by the above noted dates will be <br /> billed at the current h urly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting hat corrective actions were taken or will be taken for each violation <br /> Copies of sampleresults/rr anifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: August 09, 2018 Inspected By: JOHN ALANIZ <br /> Facility Address: 3679 S EL DORADO ST, STOCKTON CERS ID: 10185081 <br /> I certify under penalty of lav that: <br /> 1. I have corrected the violatic ns specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally,examine 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 Statement <br /> 3. 1 am authorized to submit t is certification on behalf of the Respondent. <br /> 4. 1 am aware that there are s gnificant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for kn wn violations. (HSC 25191) <br /> Name: L S< G Title: <br /> Signature: Date: ZZ � <br /> C <br />