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Ervironme tal bounty <br />i�6S1~astH� �#al Health �e <br />ole x Torre: zeltor} AvEin partrn 1 <br />{f9 468,3420 u , Stockton, Califo <br />Fax, (2G9) 458.3433 e ,,.Ow.s' ov, <br />RETURN Tn �r r�hd <br />A,yh INN Rviola "'n,nc "'i-L1� NCE ERTIF1 <br />#ecei�tof this ins #�� in the •�10#ice to rfiV <br />peGtiorr, 71�is ria Comply" in the attached Inspection Re o <br />t>�� #op of this farm-�i�lioil fo <br />within d � rnus# be Submitted to t#� , Environmetatal Healkh <br />Ys Of rece1p# of the Ins a arrecked within 7p da <br />All correctiorns to other Violatiorks noted in the per ReporR. HSC 25414,1_2(c){1) f)epan"lent s of <br />{E# -Ib) address at <br />vi01at 01) , ore to be 5u attached lrls <br />Inspertibra Re omitted using th+ ccriifica#inn ani re tion R �n[ IR) or Cant,nualion Form, or did avf <br />fork, ECSC 251 as�o}(3 P es k❑ ar�y <br />� wat�n 30 days anless Othe�,rise speafied in the <br />EEote: JII rzH[ staff t' <br />Me a�soc[ati5d with failing to corr7pi� by rho �hawe nate <br />at the currenxh0Uriy rate, <br />d dates will he billed <br />FarCertlfleticrl to be�e <br />A statement doeurnenlin , p t ' the operaiw of the 5i#e must in�Pude <br />opo 'S of sample Fe is manifesjsltra�n ng reCffedive rco dVothear en or will be la�Cerp for each vi <br />�P�ra#or's certification aP�rapriatc elation <br />Paperwork, +work, andfor photos uebfjrirtig Corrections <br />tinspecti0n Date: July 17, 2024 <br />Facility Address. 4895 3 H',+�^f <br />l cep;; und-u Renally O, 13 f that: <br />Inspect,L�d By: <br />CE RS in <br />M'ChaC'l SUszycki <br />1093M75 <br />1. 1 have corrected the viclations spedfied in the 1r SID01, ipn Report from the above-menlivned inspection date. <br />Z_ 1 have persanafty examined the followind <br />I believe the infOrma#ion la be true, acqug o Menta#icn submitted as Pref of compliance POR EACH VIOLATION and <br />rata, and complete: <br />--Photos- _p2pervrark <br />Sitem�nt <br />3. I am authorizer! #o suf mit this cergcatiOn an behalf of 11he Respondent. <br />�• I �mavrarefh�lUtieaeare SigriificantPenalties for Subrnittin <br />irnpnsonmerr# for known violalicns. {HSS X5191 9 False informal;un, in ]udir the o <br />5s <br />� � PibiPiry oFa fine andlor <br />—----- Mlle: <br />Signature:_ <br />--- -- -- ---Date: f S� <br />