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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton California 95205-6232 <br />11111 1111111111111111111111 111 Iiiiiiiiiijiiiiiiiiiilliiiiiiil 1111 1111111!1111 1 1 <br />: ♦I l'i1• •.: 1 1••.: ♦ ♦Lid. •• • • :�• <br />RETURN UV COMPLIANCE CERTIFICATION <br />Any LIJId•Q$ 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 <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All erections 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 />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 must 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 <br />corrections <br />Inspection Date: <br />2018 <br />Inspected By: STACY RIVERA <br />Facility Address: 3261 AUTO CENTER CIR, STOCKTON CERS ID: 10184969 <br />I certify under penalty of law that: <br />1. 1 have corrected the violations specked in the Inspection Report from the above-mentioned inspection date. <br />2. I have personally examined the following documentation submitt <br />ed as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos V paperwork Statement <br />3. I am authorized to submit this cert <br />ification on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitt <br />ing <br />and/or imprisonment fo ^known violations. (HSC 25191) <br />N <br />Signatu <br />false information, including the possibility of a tine <br />