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0000to to <br /> Environmental Health Department <br /> too to I , <br /> 5 �4N - 1OAQUINIn <br /> _ C 071.3vTY .. . . <br /> r ;. <br /> I <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> spect,Any M1"0 noted in the (Notion form mustce to nin the attached In I <br /> be submitted to the Environmental ntal Health ID p gent ( EHD) address at <br /> receipt of this inspection . This certification <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404 , 142(e)( 1 ) <br /> noted in the ion <br /> eport <br /> Form , or disputes to any <br /> All pgrrAC �On9 to b®heubId mitt111ed using this certification sand returtnedRo D IR, on 3Continuation <br /> dnu4 un ess othanh1 A specfied ' In the <br /> violations , are t <br /> Inspection Report. HSC 25185(c) (3) <br /> Note : All EHD staff time associated with failing to comply by the above Hated dales 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 mpledocumenting what <br /> nifests/tracorrective <br /> ln ng rteons were co ds/o her apprropriate paperworkken or will be taken for eand/orach ophtn verifying corrections <br /> • <br /> Copies of sample results/ma <br /> Operator' s certification <br /> May 17 , 2022 Inspected By : _ JOHN ALANIZ <br /> Inspection Date : <br /> Facility Address : <br /> 1612 W HAMMER LN , STOCKTON CERS ID : 10181241 <br /> 1 certify under penalt•/ 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 VIOLATION <br /> and I believe the information to be true, accurate , and complete: <br /> 10000 <br /> Photos Paperwork ,_._Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . I am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191 ) <br /> doolk <br /> Name: <br /> \3 le5 � t W �.ti `, Tyle; `` U — <br /> Date : <br /> Signature. <br /> L.CEI V ED <br /> J U N 2022 <br /> l= NVIRONMENTAL HEALTH <br /> PERMMSERVICES <br /> Received Time Jun , 1 , 2022 11 : 34AM No . 7218 <br />