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SAN JOAQUIN <br />COUNTY <br />'6'f <br />Environmental Health Department <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINER violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected w[thin 30 da s of <br />receipt of this inspection. This certification firm 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, FISC 25404.1.2(c)(1) <br />A11 corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br />violations, afe to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br />Inspection Report. HSC 251$5(c)(3) <br />Note,-. A11 EHD staff time associated with failing to comply by the above Hated dates will be billed <br />at the current hourly rate. <br />Foy this certicati <br />fio n to b e complete, the operator of the site must include: <br />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/ r photos verifying corrections <br />OPerato(s certification <br />Inspection Date: <br />Facility Address: <br />April 20, 2021 Inspected By: CLAUDIA MURO <br />720 E HAMMER LN A-3, STOCKTON0CERS IflP=6 <br />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 />. 1 have personally examined the following documentation u bm itt d as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />. I am author zed to submit this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitting false information, including the possibility of a Tine <br />andlor imprisanm t for known violations. HSC 25191 } <br />00" <br />j / /Owpm <br />Name: F47 4 Title: 040fool-4t <br />Signature: <br />Date: v � 2 Wr 2 <br />1 <br />