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S A N 10 A Q U I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Anv 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 /> Ali corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations.are to be submitted using this certification and retumed to EHD within 30 days unless otherwise specified in the <br /> Inspection Report HSC 25185(c)(3) <br /> Note: All EHD staff time associated with falling 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 include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: May 30, 2025 Inspected By: ALLEN ASIO <br /> Facility Address: 1612 W HAMMER LN, STOCKTON CERS ID: 10181241 <br /> certify under penalty of law that: <br /> I 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 <br /> and I believe the information to be true,accurate,and complete: / <br /> Photos Paperwork II Statement <br /> i <br /> 3 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penatties for submitting false information,including the possibility of a fine and/or <br /> imprisonment for known violaaboonns. (HSC 25191) <br /> Flame: �� S 7 1 Uj 6, Title: Cy <br /> Signature Date: <br />