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Piiwti Environmental Health Department <br /> SANsJOAQUIN p <br /> COUNTY-- <br /> ,�4i�,�e�`* Greotness grows here. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected <br /> within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental <br /> Health Department(EHD) address at the bottom of this form within 30 days of receipt of the Inspection Report. <br /> HSC 25404.1.2(c)(1) <br /> All corrections to otther violations noted in the attached Inspection Report (IR) or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed <br /> 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 corrections <br /> Operator's certification <br /> Inspection Date: August 31, 2021 Inspected By: SHEWIT WOLDEAREGAY <br /> Facility Address: 1030 S OLIVE AVE, STOCKTON CERS ID: 10180695 <br /> I 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 /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH <br /> VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos x Paperwork x 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Martin Hilfin er Title: Vice President <br /> Environmental Affairs <br /> Signature: Date: 9/29/21 <br />