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SAN JOAQUIN Environmental Health -0�� p�: r1a:zn � <br /> 0 U IN I Y <br /> . e r i r <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINER 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 farm must be submitted to the Environmental Health Department (EHID) 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 (11R) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHQ 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 th is certification to be compete , 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 recordslather appropriate paperwork, and/or photos verifying corrections <br /> • <br /> Operator's certification <br /> Inspection Date : March 31 , 2022 _ Inspected By: GABRIELA GARCIA-MEMA <br /> Facility Address: 3239 S EL DORADO ST, STOCKTON CERS !D . 1X183211 <br /> 00000� MEN <br /> I certify under penalty of law that.- <br /> 1 . <br /> had:1 . f have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. I have personally examined the fallowing documentation submitted as proof of compliance FOR EACH VIOLAT1dN <br /> and 1 believe the information to be true, accurate , and complete : <br /> Photos Paperwork Statement <br /> 3. ! am authorized to submit this certification an 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 /> IS <br /> Name: / JW6 Title: PA'Al 14 <br /> Signature: Dale : � �`�� V, <br />