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RECEIVED ON 12/19/2022 (3 PAGES) <br /> � E6u�, li:�C�ul,t�:�����iu nu�.�'��a�lL�� Jai�?i�. c.l�fil� <br /> 7 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 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 25404.12(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(I R)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 ftaling to comrMy by the above doted dates will be <br /> billed at the oMrrent 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 /> lnspectlora 0aft'e March 30, 2022 lnspe@ted By: JOHN ALANIZ <br /> IFac city Address: 2512 E WATERLOO RD, STOCKTON _ CERM W: 10181585 <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 !`_ Paperwork 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 and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: <br /> �P�' Title: L <br /> Signature: `�� Date: ) <br />