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V I Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> N <br /> Any 14�4 NEE vinliatlons noted In tile'Nullce Iv Cal»ply' In the aNadied fnapadbn Report mull he ggggclW wM10 N dgys of <br /> reompt cat Chas InspeclIon, TbIs ccurllflcattorr form mu$t be submitted to the Environmental Heallh Npar1ment(r:HDD address al <br /> the#ottom of#hls fonn vAlf in 30 daya Or receipt of tfio Inspection Repnrl, HSG 25404.1,2(c)(I) <br /> Ail M n tot an Hater!In the a#tAChad Ins eclIon Report (II )or ConlinUEMOn Form. or disputes 10 any <br /> uinlalinns,are to be%pbmilted using Ihia cmcfiileafion and raturried to EHD within 3O days unless rrtf onmIse s r-Med In rho <br /> Inspection Depot. HSC 251a5(cX3) <br /> Note: Al EH 1) staff time assoclated with failing to comply by the above rioted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the aperalor of the Site must include- <br /> A slate"r,t docunkenling what corrective actlons were taken or will be taken for each 001etion <br /> Gapies of sample resultsFinan4estsltraining reeardskothar appropriate paperwork.andlor phol45 verifying corrections <br /> Operatar's certification <br /> Inspection Date: September 26, 2025 Inspected By: ALLEN ASI0 <br /> Facility Address: 1941 E LO KHEED CT, STOCKTON CERS ID: 10181291 <br /> 1 certify uoder 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 persurially examined the following documentation submitted as praaf or compwance FOR EACH VIOLATION <br /> and I believe the inforrnaka to be true,accurate. and complete: <br /> Photos PaperworkxStatement <br /> 3. 1 am authortxad to submit this certi€catlon 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 an(Yor <br /> imprisonment far known virAaUans- (HSC 25191) <br /> Name: o F �4 � _ Tittle: 1) P C)4 r ( 1 <br /> Signature: Date, f C (I <br />