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{ Environmental Health Department <br /> rY - SAN � � OAQ11N <br /> , COUNTY <br /> �. fWp <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 26404.1 . 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 falling 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/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator' s certification <br /> Inspection Date. October 24 , 2018 Inspected By % LYDIA BAKER <br /> Facility Address : 601 Nestle Way , Lathrop GERS ID : 10184441 <br /> I certify under penally of law that: <br /> 1 . I 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 *S//Paperwork Statement <br /> 3 . 1 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 /> r� <br /> Name: '01`�IC lU I Title : Ti ' �� L <br /> Signatu�- : � d pate : <br /> 1868 E. Hazelton Avenue i Stockton , California 95205 T 209 468-34201 F 209 464-0138 1 www. sjcehd .com <br />