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kivironm ! <br /> ntal t4ealth Depa�mex�4. <br /> ' • SAN <br /> GL) ! 1 <br /> CE CERTIFICATION <br /> RETURN TO CO(VIpLIAN be corrected Within 30 da s of <br /> Report must EHD address at <br /> t ' in the attached Inspection Rep Department ( ) <br /> Any MINOR violations noted in the " Notice to Comp e ortHSG 25404 . 1 2 (0) (1 ) <br /> on . This certification form must be submittedd to the Environmental Health <br /> receipt of this inspect) s of recei t of the Inspection p <br /> p utes to any <br /> the bottom of this form within 30 day eport ( IR) or Continuation Form , or disp specified in the <br /> All corrections to other violations noted I certifi t t on and returned ed Inspection Rto EHD within 3�S unless otherwise <br /> violations , are to be submitted using <br /> this Inspection Report , HSC 25185(c) (3) <br /> ed With failing to comply by the above noted dates will be <br /> Note : All <br /> time <br /> nt hourly rate. <br /> htlled at the cur <br /> For this certification to be complete , the operator of the site must include: <br /> g what corrective actions were taken s paperwork , and/or <br /> e a eo <br /> lation <br /> A statement documentinphotos verifying corrections <br /> Copies of sample results/manifests/training records/other appropriatep <br /> • Operator' s certirication <br /> Inspected By : PAUL NSO <br /> inspection Date : November 19 , 2020 p <br /> Facility Address : 1916 E MARCH LN , STOCKTON <br /> CERS ID : 10186995 <br /> I certify under penalty of law that : <br /> 1 . I have corrected the violations specified in the Inspection Report from the above- mentioned inspection date . <br /> 2 _ I 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 /> l <br /> Photos PapviwQrk S{a{emnnt <br /> 3 . I am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations . (HSC 25191 ) <br /> n <br /> Name : � �� U Title: � YILd � <br /> Signature : I Date: C, <br /> P <br />