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Sar:Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenu Stockton,California$5205-6232 <br /> Telephone:(2091)468-3424 Fax:(209)ASS-3433 Web:www.sigov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> AnyI+l NOR 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 subrniftd to the EnvironmenW Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2je)(1) <br /> All Arrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violaijons,are to be submitted using this certification and returned to EHL) within 30 days unless otherwise specified in the <br /> InsDdelion Report. NSC 25195(cX3) <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 opeiAWthe site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resultslmanifestsftraining recordslother appropriate paperwork,andlor photos verifying <br /> corrections <br /> Inspection Date: November 26,2018 Inspected By: JOHN ALANIZ <br /> Facility Address: 2041 NAVYCKT N C RS la: 10184601 <br /> I certify under penafly 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 Mlowing documentation subm dtWs proof of compliance FOR EACH VIOLATION <br /> and I believe the Information to be true, accurate; and complete: <br /> X x x <br /> Photos Paperwork Statement <br /> 3. 1 am authonzed to submit fts certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting &JIhformation, including the possibility Df a fine <br /> and for imprisonment for known violations. (HSC 25191) <br /> Name: U Title: <br /> Signatur date: 12/19/2018 <br /> 2/19/2018 <br />