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SAN J O D I N Environmental Health Department <br /> RETURN! TO COMPLIANCE CERTIFICATION <br /> Any MINQR violations noted in Ihe'Noli to CornPly" v1 the attached Insion i=keparl nlust be Corrected within 3p days of <br /> receipt of Ihis insi This Certification form mull be submitted to the Environmarttal Health Department(EHD) address at <br /> the bottom of this form wilhin 30 days of receipt of the Inspedion Repo ri. HSC 25404 1.2{c)(1) <br /> All correcaaana Lg WbgrvIplailcons noted in the attached Inspection Report(IR)or Continatatipn Forrrt, or disputes to any <br /> vrolation9, ans Io besubmiii Using this cer'llfrcation and returned to EHD wri 30 days unless otherwise specified in the <br /> Ingi Report, HSG 25165(c)(3) <br /> Nate: All EHD Staff time associated with failing to comply by the move Poted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be Complete, the operator of the site rausl Include: <br /> Astatement documenting what corf e ctive actions were talcen orwill be taken fat each violation <br /> Copies of sample resultslmanifesti0iraining fecardsfpther appropriate paperwork, anftr photos verifying cwmci <br /> Operator's ca6fiicalion <br /> Inspection Data: July 08, 2028 Inspected By: LYNSEY SAMMONS <br /> Facility Address: 1877 Industrial ❑r, Stockton CERS 1 10186783 <br /> 1 certify under ponal(y of law that <br /> 1 1 have Corrected the vio iprlg specified in the Inspection Repan From the abowa:-mentioned iP.spectilm date <br /> 2. 1 Wve personally examined Lie fallowing docurraenkation submitted as proof of Complian ce FOR EACH VICtAT10N <br /> and r believe the information t4 be true, accurate, end Complete <br /> ,Pi_ PaperworM X Statement <br /> 3. 1 arra authorized to submit this inaitfication on behalf of the Rio soondent. <br /> 4. 1 ern aware Ihat there are signii perlaaltles for submitting false information, including the passib.Il;y of a fine andror <br /> imprisvnrnent for known viofatlons (HSC 2519 1) <br /> Nai Daniel Bell Tii Maintenance Supervisor <br /> Signature Date: 1013125 <br />