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SHAUN Environmental Health Department <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 25404.1.2(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 cave unless otherwise specified in the <br /> Inspection Report. HSC 251e5(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/manifestabaming records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: February 15,2023 Inspected By: HAZA SAEED <br /> Facility Address: 9974 E FAIRCHILD RD, STOCKTON CERS ID: 10181809 <br /> I certify under penalty of law that: ,t 4 L, -.�iq l <br /> / <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned insp ection 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. (HSC25191) <br /> Name: Title: Lam/, /It ,;'— <br /> Signature: Date: Z�3 <br />