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s4lN OWN <br /> I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any NllNOR violations noted in the `Notice to Comply" in the attached inspection Report must be corrected within 30.0 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 Repan. HSC 250404 1.2lcf(t) <br /> All cprrections to o1her noted in the attached Inspection Report {1R) or Continuation Form, or disputes to any <br /> violations,are to be submitted using this Gerltfication and returned to EHD within 34 day unless Otherwise sPec'fied in the <br /> Inspection Report. HSC 25185i[c}t3y <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 resultslmanifestsrtrainmg recordsr'other appropriate paperwork, andlor photos verifying corrections <br /> Operators certification <br /> Inspection Data: March 30- 2020 Inspected By: PAUL NSO <br /> Facility Address: 8606 THORNTON RD STOCKTON CERS lD: 10180975 <br /> I certify under penalty of law that <br /> 1. 1 have corrected the violations specified :n the Inspection Report from the above-mentioned inspection date <br /> 2. 1 have persona[ly examined the following documentation submitted as pfoof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate, and compiete <br /> Photos / Paperwork ✓ Statement <br /> 3 1 am authorized to submit this cert ification on behalf of the Respondent <br /> 4 1 am aware that there are significant persalt+es for submitting false information, including the passibility of a 4ine <br /> andlor imprisonment for known violations (HSC 25191) <br /> Name. 1\1A� iks� Title: L3w Ca <br /> Signature: -fes Date: - 3 <br />