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San Joatitrin Cotinty <br /> Environmental Ifenlih Ur.partment <br /> ttlC+t1 EeRI Haretinn Avantre,Stockton,CWrwnia 98205.6232 <br /> ref(li►hone.-(20ft)4811-3420 Far:(NVq)49FI.3431 Web;Wfm 5LgrA.orolstrd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR vlolallone noted In thr"Noflr-e to Comply' In tho attncW Insp"etkm Rooprid mr,gt he v,rrectQd 'ft 30 d of <br /> receipt of this Inspection. This cedifir-tlon form mull he suhm4M(d to the ErMfonmeniat Henith bnpartmeni(EH())addresq 31 <br /> The top of this form within 30 days of receipt of the Insp. lion Report. 148C 25404,t.2(rl{1) <br /> All corrections to other violations noted in ilia attached inspection Report(lit)or Continup&rin Form,or rfigputPq it)any <br /> violations.are to be submitted using this certification and returned to DID within 30 des unlesq ,pnr,rrad,n thrg <br /> Insper:sion Report. HSC 25196(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be hilted <br /> at the current hourly rate. <br /> For this certification to be complete, the operator of the site must inctude. <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resultslmanifestsllraining recordslother appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> September 17,2024 Mana Lopez <br /> Inspection Date: Inspected By: <br /> Facility Address: 2072 W YOSEMITE AVE CERS ID: 10181669 <br /> I 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 and <br /> I believe the information to be true,accurate,and complete: <br /> Photos Paperwork Statement <br /> 3. f 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. (HSC 25191) <br /> Name: Title: <br /> Signature: Date: <br /> ----------------------------- <br /> Scanned with <br /> CamScanner- <br />