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SAN J O A Q U I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR v olations 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 his 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,areto be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Re )ort. 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 sta ernent documenting what corrective actions were taken or will be taken for each violation <br /> Copi(:s of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> OperItor's certification <br /> Inspection Date: April 15, 2021 Inspected By: CAROL PRESTO <br /> Facility Address: 10715 Trinity Pkwy, Stockton CERS ID: 10760026 <br /> 71certify 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. 1 haNe 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 X 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 /> and/d.,imprisonment for known violations. (HSC 25191) <br /> Name: )-dr- <br /> - Title: /�c7� G•- <br /> Signatu.e: -r�'�� Date: 'Z <br />