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a <br /> SAN 10AQUIN Environmental HREOEWE& <br /> —COUNTY NOV 23 2022 <br /> Grectness groves here!. <br /> E I ONMENTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATE RMIT/SERVICES <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 <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: October 26, 2022 Inspected By: ROBERT LOPEZ <br /> Facility Address: 3932 BUDWEISER CT, STOCKTON CERS ID: 10183085 <br /> 1 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 andk <br /> imprisonment for known violations. (HSC 25191) L <br /> Name: zua nn Alusci 1't Title: lar, / ��a�.1 (?_r <br /> 20 <br /> Signature.- Date: <br /> / Z- <br />