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S A N J O A Q U I N 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 correctioAs to other violatioAs Aoted iAthe attached IAspectioA Report(IR)or CoAtiAJ2tioA Form,or disputes to aAy <br /> violatioAs, are to be submitted usiAg this certificatioA aAd returAed to EHD withiA30 days uAess otherwise specified iAthe <br /> IAspectioA Report. HSC 25185(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 Aclude: <br /> A statemeAt documeAtiAg what corrective actioAs were takeA or will be takeAfor each violatioA <br /> Copies of sample results/maAifests/traiAiAg records/other appropriate paperwork, aAdlor photos verifyiAg correctioAs <br /> Operator's certificatioA <br /> Inspection Date: February 18, 2025 Inspected By: LYNSEY SAMMONS <br /> Facility Address: 3437 S AIRPORT WAY, STOCKTON CERS ID: 10153883 <br /> 1 certify uAder peAalty of law that: <br /> 1. I have corrected the violations specified iA the IAspectioA Report from the above-meAtioAed iAspectioA date. <br /> 2. 1 have persoAally examiAed the followiAg documeAtatioA submitted as proof of compliaAce FOR EACH VIOLATION <br /> aAd I believe the iAformatioAto be true,accurate, aAd complete: <br /> Photos Paperwork /StatemeAt <br /> 3. I am authorized to submit this certificatioAoA behalf of the RespoAdeAt. <br /> 4. 1 am aware that there are sigAificaAt peAalties for submittiAg false WormatioA, iAcludiAg the possibility of a fife aAd/or <br /> imprisoAmeAt for kAowAviolatioAs. (HSC 25191) <br /> Name: ov�`rA"I") Title: VAC-*, 1 ;T1's S EN I;I'Z'IF'e— <br /> Signature: Date: <br />