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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue , Stockton , California 95205-6232 <br />Telephone: (209 ) 468-3420 Fax : (209 ) 468-3433 Web: www. sjgov . org/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any 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 <br />at the top 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 Continuation Form , or disputes to any <br />violations , are to be submitted using this certification and returned 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 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 />Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying <br />corrections <br />Operator' s certification <br />Inspection Date : April 18 , 2022 Inspected By : Carol Presto <br />Facility Address : 487E SIXTH ST STE ACERS ID : 10791172 <br />I certify under 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 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 Statement <br />3 .1 am authorized to submit this certification 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 <br />and/or imprisonment for known violations .HSC 25191 ) <br />Name : Title. <br />Signature : Date: