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20230810_142842.jpg I Download Full screen Ig Print n Save to OneDrive m Shovt <br /> 11J 0 U,ti Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> A^,%,%, v,oatioft noted in Na'Not u to Compy,n the attaU+ed Irspect:on Report must be w^ected wi:lhm 30 days of <br /> -ere::a:hs nspecton.This ee".,C81o1 tor,must be sutxn.ted:o the Enwonrrantal Health Department(EMO)address at <br /> :-e bmom of r s form mNn 30 days of rece pt o'the Inspection Report. MSC 25s04.1.2(cxt) <br /> A'x-ecoors to o7+er vio=21 noted n the a'achae lnspemon Report(IR)or C intnuatan Form,or disputes:o any <br /> vz axns.aro tc be submMed using this cerufcatwn and ret..med to EHO within 30 days unless otherwise speofied in the <br /> -Report. HSC 25185;cX3) <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 s:e must include <br /> A s:a:e^+e':Cowie^,q w*a:conecz"ac:ons were taken or will be taken for each violatwn <br /> Copies o'sa-ple resurs'manreVW&.ra ring record&other appropriate pope,-" ar6'or phc:os ven-png oomecbons <br /> opemtois ceru5015on <br /> Inspection Date: August 07,2023 Inspected By: ALBERTO FERNANDEZ <br /> Facility Address: 2757 BOEING WAY.Stockton CERS ID: 10726129 <br /> ,--i --Ce,Denary of urm that <br /> t I nave conoctod re vrola3ms speohed in Ne Inspector.Report from Ne above+nenxred aspect:on date. <br /> 2. 1 havo porsonaily examined Ne following documen:a:wn submitted as proof of compliance FOR EACH VIOLATION <br /> and I be:eve 74 nforma:ion:o be tnx.xw�ate,and complete- <br /> d//Photq PYPewak Statement <br /> 3. 1 am a-j-,r rzoC to submit Nis conficaton on behalf of the Respondent. <br /> A. I am aware that Here a•e s-ynif w�i penattwil for wbmrmng false erfemabon,rnduC.ng"poss Wily of a one <br /> &-4,or n,pniso"ment for know^..,uet ens. tHSC 25191) <br /> Name: /eoO�ri�p �)O»r.e le 2 Tale Wd(�N((I[ /Y1tat�t <br /> Sigrature. Date'.SAA.? <br /> RECEIVED <br /> SEP 0 8 2023 <br /> ENVIRONMENTAL HEALTH <br /> PERMITiSERVICES <br />