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Fnvironmental Health Depart ent <br /> S A N ,,,, J 0 A QUIN <br /> k C) U Y <br /> N I <br /> it -4 W Greotmess grows hcte# <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Coniply" in the attached Inspection Report must be corrected wi#hin 3Q.LaLs.. 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 corrections to other violations noted in the attached Inspection Report (IR) or Confinuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 34 d unless otherwise specified in the <br /> Inspection 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 include <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copes of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : May 07 . 2025 Inspected By : KRISTINA SAETERN <br /> Facility Address : 713 N ELDORADO ST, STOCKTON CERS I D : 10 184731 <br /> I certify under penalty of law that , <br /> 1 . f 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 tree , accurate, and complete : <br /> Photos - Paperwork Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent . <br /> rpossibySit of a fine andlor <br /> �4 . I am aware that there are significant penalties for submitting false rnfo matron, inciudmg the y <br /> imprisonment for known violations (HSC 25191 ) <br /> R <br /> Name : �4 � � �'l.�n.r 5 � Title -. 2 jC4-140�' <br /> Signature: Date : <br />