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S N ; ^ J O AQ U , Envilronmential Health Department <br /> $1 1 ..... 0 CacJ N r' Y ......�.,.. <br /> d AL <br /> r ' .: .n ' . . . . . <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MING violations noted in the " Notice to Comply" in the attached Inspection Report must be =ie6Xed 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 correotio stp <br /> her violationaL noted in the attached Inspection Report (IR) or Continuation Form , or disputes to any <br /> violations , are to be submitted using thls certification and returned to EHD Atkin 30 days unless otheiwiae 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 : June 14, 2022 Inspected By : CAROL PRESTO <br /> Facility Address : 1210 E HAMMER LN , STOCKTON CERS ID , 10181355 <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, I 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 L / Paperwork Statement <br /> 3 . 1 am authorized to submit this certlAcation on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information , including thea possibility of a fine <br /> and/or, imprisonment for known violations. ( HSC 25191 ) <br /> �- <br /> Name : — I -� w a,�^ Title ; <br /> Signature, Date : <br /> Received Time Jun . 29 , 2022 3 : 03PM No . 1250 <br />