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mal• <br /> Environmental Health Department <br /> SAW]OAQUI <br /> t":1 j ---_-C o u N T Y--•--_ <br /> `c'rttFezA'�r Greatness gro:vs herr. <br /> RETURN TO COMPLIANCE CERTIFICATION <br />,Un <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days of <br /> ation receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address at <br /> Ition i the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />;ertifl� <br /> 28 of 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 /> SING Inspection Report. HSC 25185(c)(3) <br /> Mon! 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 /> PcolA 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 /> rn r Inspection Date: February 24, 2021 Inspected By: VICKY YANG-LEE <br /> i'natE Facili Address: 16 E HARDING WAY, STOCKTON CERS ID: 10181239 <br /> 9 tY <br /> I certify under penalty of law that: <br /> ed 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> ken t, 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 1/ 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 /> th t� and/or imprisonment for known violations. (HSC 25191) ej <br />� Name: �"� �`' Title: <br /> ud( <br /> tal Signature: Date: f <br /> k <br />