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SAN J OAQ V I N Environmental Health Department <br /> C. V�J 'NTY <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 at <br /> the bottom 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 f=orm. 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 billed <br /> 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 resuitslmanifestsltraining recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: February 22, 2021 Inspected By: VICKY YANG-LEE <br /> Facility Address: 2057 S EL DORADO ST, STOCKTON CERS ID: 10181361 <br /> 1 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. 4 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 X 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 /> andlor imprisonment for known violations. (HSC 25181) <br /> Name: AIED S. DOBASHI Title: PRESIDENT <br /> Signature: Date: 03/26/2021 <br />