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i <br /> S Q N Q Q ' � ( N Environmental Health Department <br /> % <br /> I � <br /> I <br /> RETURN TO COMPLIANCE ' CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection . This certification 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 using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report , HSC 25185 (c) (3) , <br /> Note : All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate . <br /> For this certification to be complete , the operator of the site must include : <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/m nifests/training records/other appropriate paperwork , and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date : Decem ! er 17 , 2018 Inspected By : LYDIA BAKER <br /> Facility Address : 2323 V�Ii PORT RD , STOCKTON CERS ID : 10182465 <br /> I certify under penalty of law that: <br /> 1 . 1 have corrected 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 Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are siignificant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations . (HSC 25191 ) <br /> Name: 1 tC I � . L �5��� Title� <br /> n <br /> Signature : L( C. Date : � rC <br /> i <br /> I <br /> 1868 E . Hazelton Avenue Stockton , California 95205 I T 209 468-3420 1 F 209 464-0138 1 www . sjcehd . com <br />