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SAN 10AQUIN Environmental Health Department <br /> COURJTY <br /> t <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 davs 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 <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 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 15 , 2022 Inspected By : ROBERT LOPEZ <br /> Facility Address . 1282 Shaw Rd , Stockton CERS ID : 10181389 <br /> I certify under penalty of law that : <br /> 1 . 1 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 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 possibility of a fine andA <br /> imprisonment for known violations . ( HSC 25191 ) <br /> Name : <br /> Kenneth Rose Title : Dir . Engineering & Environmental <br /> 3/ 15/2022 <br /> Signature : oc 40M A Date : <br /> RECEIVED <br /> MAR 21 2022 <br /> LI& IRONMENTAL HEALTH <br /> PL= RMIT / SERVICES <br />