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SAN J A Q U I Environmental Health Department <br /> C O UN.- <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations holed in Ole'Notice to Comply'm the attached Inspecton Repod mull be Correcled within 30 days of <br /> receipt of lhrs irispeetton. This cerfification farm must be submit!I�to the Environrnanial Health Department(EHD)address ai <br /> the bottom of this form within 30 days of receipt of like Inspection Report. HSC 25404.1.2(CXI) <br /> AtC DIDUactions IQ olftef violations noted in the attached Inspection Report(IR)or Conlinuation Form,or disputes to any <br /> violations, are 10 be subaxtrtted using this certeficabon and returned to EH within 5 unless otherwise specified rn the <br /> Inspection Report. H5O 25165(c){3} <br /> Mote: All E H D staff time assocleted with failing to comply by the above noted dates will be <br /> bWed at the current hourly rate. <br /> For this certification to be complete, the Operator of the site must Include' <br /> A sletement documenting what mrreC;ive actions were taker? or will be taken for each violation <br /> Copies of sarnpEe resuftS marufestsltraining recordsfother appropriate paperwork, andfor photos verifying Comectiona <br /> Operalor's cerlirrahco <br /> Inspection Date: November 26. 2025 Inspected By: ALLEY!AS10 <br /> Facility Address: 1501 W CHARTER WAY, STOCKTON CERS ID. 10181557 <br /> 1 cerlify under penalty of law that <br /> 1_ I have Corrected the v olations specified in the Inspection Report from the above-mentioned inspection date_ <br /> 2. I have personalEy examined the follcwjng documentation submitted as proof of complragce FOR tAQH VIOLATION <br /> and I believe the informalion to ba true,accurate, and complete: <br /> Photos Paperwork_Statement <br /> 3_ 1 am authorized to submit this cerlificalion on behalf of the Respondent, <br /> 4, 1 am aware that(here are significant penalties for submi#ting false inforrrmetfon, including the pOssibelily of a fine endlor <br /> imprisonment far known violations. (HSC 25191} <br /> Name: Mike Eliason Title: Cardlock Manager <br /> Signature: Date; 121212025 <br />