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UIAW <br /> qdw� °7 SAN JOAQUIN Environmental Health Department <br /> ' ; - COUNTY <br /> OF arss <br /> ' 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 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 /> 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 specified in the <br /> 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 : February 16 , 2022 Inspected By : LYDIA BAKER <br /> Facility Address : 4511 PACIFIC AVE , STOCKTON CERS ID : 10180943 <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 VIOLATION <br /> and I believe the information to be true , accurate , and complete : <br /> Photos Paperwork Statement <br /> 3 . I am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 1 am aware there are si scant penalties for submitting false information , including the possibility of a fine <br /> and/or im riso ment for knwn iolations . (HSC 25191 ) <br /> Name : 19N ) Title : 1 l�'► -Q (r <br /> Signature : — Date : 3 72 <br /> M3KWVd30 H1Td3H - <br /> RECEIVED TUN3WNOUTAN3 <br /> ZZO ? 0 NVN <br /> MAR 0 7 ? <br /> ENVIRONMENTAL (13AI303d <br /> HEALTH DEPARTMENT l �y <br />