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SAN ^ �aAQuiN Environmental Health Department <br /> ��'• , ,�� Ciceeat++ea� �►e►w� here• <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> rely AIINQK violations, noted In the °Nofico to Comply- in Ilio ottoc•hod Inspection Ropoit must be corrected within 30 days of <br /> rocatlif of Ihisc Ins:partiorl. 1"Ilim corlifirotion fotnl must hr subnlittod to tits Ealvhoil mertal Hotilth Department (EHD) address at <br /> tho bottom of tills: forrll within 30 day::of rocoipt of tho Insapoction Ropoit NSC 25404.1.2(c)(1) <br /> All{ILLga- tjLGi t�, ulllttLYl��htth�ll .ncltod In tho attached Insportion Ropoit (IR) or Continuation Form, or disputes to any <br /> yiolstions, Attie ho submittod usinit fills. catlifivillion and rolurnod to FI-ID within 30 days unloss otherwise specified in the <br /> Inspection Ropoit ITC 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, ow operator of the site must iilcimjvP <br /> A slntonlont dor.rinlonlirlif what corrortivo actions warn takon or will betaken for each violation <br /> Copies of s ollipio Ivsarrlts/n111111 cash/htit Ili Ili I rocords/othor appropriate paperwork, and/or photos verifying corrections <br /> 011or11tor's certification <br /> Inspection Date: Sopteniher 23, 2021 Inspected By: ROBERT LOPEZ <br /> Facility Address: 3230 F Mair St, Stockton CERS ID: 10711729 <br /> 1 comity under poncllty of Inw that, <br /> 1. 1 have cotroctod thea violations spocifiod in tho Inspoction Ropoit frons the above-mentioned inspection date. <br /> 2. 1 hnvo poisomilly ex(lnlinexf tho following doc tinlontation submitted as proof of compliance FOR EACH VIOLATION <br /> rind I bolrovo tho information to ho huo, accurnto, and complotel: <br /> Photos \4_ Puporwork ___)[._Statoment <br /> 1 1 urn rluthorirod to submit Illis cvitilication on helhnlf of lhel Rospondenl. <br /> 4 1 tial uwaro thcU thoto ;no significl.lrlt ponaltios for submitting false information, including the possibility of a fine and/( <br /> hnpiisonniont lot known violations. (NSC 25191) <br /> Nan)e:_._ ��1_c_k k'1C) _ Title; (�Wner <br /> -2.Q f <br /> Slgnature�_ -- _, Date: 2U 2 <br /> L <br />