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. : : h: Environmental Health Department <br /> fIrSAN JOAQUIN <br /> FI t d _ - - C0UNTY — <br /> Greot � ess yrutivs here . <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/manifests/training records/other appropriate paperwork , and/or photos verifying <br /> corrections <br /> Operator' s certification <br /> Inspection Date : August 27 , 2018 Inspected By : KASHIF ALI <br /> Facility Address : 13900 S HARLAN RD , LATHROP CERS ID : 10186941 <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 : r <br /> Photos Paperwork �/ Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4 . I 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 ) e _ <br /> Name : [ � ) �, rl '! Title : eerJI CSL V `r ' Oln Ck <br /> Signature: Date : C 11 <br /> 1868 E . Hazelton Avenue I Stockton , California 952051 T 209 468-3420 I F 209 464-0138 1 www. sjcehd . com <br />