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:j0A,J104 � I`i Environmental Health Department <br /> � _. H <br /> f <br /> a <br /> rzatriess grow$ 6erc- <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 days of <br /> receipt of this inspection. This certification form 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. HSC 25404.1.2(c)(1) <br /> n the <br /> ion <br /> m,or disputes to any <br /> All corrections to otheubmlatio using this certificafon and returnedattachd Inspection anEHD Iw tKn 30 daystunless rotherwi�se specfied n the <br /> violations,are to be s <br /> Inspection Report. HSC 25185(c)(3) <br /> sociated with failing to comply by the above noted dates will be <br /> Note: All IEHD staff time as <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 correctiveriate paperwork,and/or photos actions were taken or will be taken for each violation <br /> verifying corrections <br /> Copies of sample results/manifests/training records/other appro p <br /> Operator's certification CAROL PRESTO <br /> Inspected By: <br /> Inspection Date: February 08, 2022 — <br /> CERS ID: 10180899 <br /> Facility Address: 437 N WILSON WAY, STOCKTON <br /> rjce;rtify under penalty of law that: <br /> ve corrected the violations specified in the Inspection Report from the above-mentioned <br /> 1. I ha roof of compliance FOR EACH VIOLATION <br /> 2. I have:personally examined the following documentation submitted as p <br /> and I believe the information to be true,accurate,and complete: <br /> Paperwork 4—Srn <br /> tateent <br /> Photos -- <br /> 3, 1 am authorized to submit this certification on behalf of the Respondent. <br /> penalties for submitting false information,including the possibility of a fine <br /> q• I am aware that there are significant p HSC 25191) <br /> and/or imprisonment for known violations. ( <br /> Name:_ <br /> _Date, <br /> Signature: <br /> h� E � <br /> I <br /> �arof pregto <br /> 1 / : 11 ' <br />