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San Joaquin County <br />Environmentai Health Dep artment <br />1868 East Hazelton Avenuo. Stockton, California 95245.6232 <br />Telaahone- (209) 488-3420 fax, (209) 468.3433 Woh: www.s0gay.orgh3`hd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MIN violaWns noled In the "Notice to Comply" In the attached lospectlon Reporl must 49 correcled withln 30 days of <br />raceipt of this inspection_ This certlficafion form musk be submitted to the Environmental Health Department (EHD) address al <br />the top of this form wilhin 30 days of receipt of the Inspection Report. HSC 25404.1,2(c)(1) <br />All correction F. to other. V± Q!12tions naiad to ffie attached lnspectlon Report (IR) or Canfinua0on Form, or disputes to any <br />violations, are to be submitled Using this certifiGatiun and returned to EHO within 30 days unless otherwise specified In the <br />lnspection Report, H C 25185(c)(3) <br />Mate. All 1 HD staff time associated with failing to comply by the above noted dates will be Ib€fled <br />at the current hourly rate. <br />For this certification to be complete, the operator of the site must include'. <br />A statement documBn1ing what corrective actions were taken or will be taken for each viola tion <br />Copies of sample re sutlsimanifestsftraining record siothe r appropriate paperwork, andlor photos verifying corrections <br />Operator's cartificalian <br />Inspection Date: May 21. 2024 <br />Facility Address: 28DO TURNPIKE RD <br />I certify under penalty of law that: <br />Inspected By: <br />Lyosey Sammons <br />CER ID: iG181403 <br />i. I have corrected the Oolafions specified In the Inspeclion Report from the above-mentloned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and <br />I betleva Char infprmahon to ha Iru9, accurate, and ccmpletia' <br />Phatus Paperwork ` + Slaternent <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 passibility of a fine andivr <br />imprisonment for known viafatlons, (HSC 25191) <br />Naive: EPIk_&IJI"'I Title' >hyr'l <br />Date: <br />Signature: r�r 0 <br />