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Environmental Health Department <br /> StTN <br /> .a.4e: .art• .�.:.�..: <br /> r�y`�.1,�'R�J;�' :�:�ri4Y.�!T�,'lNi. 1,1:IR'i:.':•�'Q;F,��: <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 corraCtions to otheryi0lations rioted in the attached Inspection Report(1R)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 muat 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 corrections <br /> Operator's certification <br /> Inspection Date: December 09, 2020 Inspected By: CAROL PRESTO <br /> Facility Address: 2701 W MARCH LN, STOCKTON CERS ID: 10181433 <br /> 1 certify uncltr 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-- <br /> Photos PaperworkStatement <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 /> Names Title: <br /> v <br /> Signature: ri Date: - ra `0?C) <br /> Received Time Feb. 15, 2021 1 :41PM No, 6604 <br />