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San Joaquin County. <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton, California 95205-6232 <br /> Telephone: (209) •4681113420 Fax; (209) 468-3433 Web, www.sigoy.or.Q1ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR 'violations- noted In the " Notice to Comply" in the attached Inspection Report must be :corrected within 30 deiVs 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. 1It <br /> .2(cj( 1 ) <br /> 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 speelfied ]n the . :. . <br /> Inspection Report. HSC 25485(c)(3) It <br /> It <br /> Note:. All * EHD staff 4time associated: with failing' to comply 'by the above noted dates Wit be <br /> --i- -- - ._._bP11ed�'t tf�e:carfent'tresu'rl Y. rate . ._. <br /> For this certification to be complete , the .operator &ofthe 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 /> Operator's certification <br /> Inspection Date : June 03, 2021Inspected By : Paul - Nso . <br /> Facility, Address:. 1399E YOSEMITE AVE . CERS I'D:: 10180675 <br /> I certify: under penalty of law that! <br /> 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 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 Paperwork C,04tatement <br /> 3 . 1 am authorized to. sui?mitthis certification. on behalf of the Respondent. <br /> 4. 1 am awareahat there are significant penalties for submitting false information, including the. possibility of a fine . . <br /> - e <br /> and/or 1mprlsonment for known violations : ( HSC 25191) <br /> Name: ` h {t. Title• rj m% fY\ <br /> Signature: _ . . . . . v . . : -- Date: <br />