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SAN , JOAOUIN Environmental Health Department <br /> - (', OUI`ITY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> AnyIM NOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 des of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department (EHD) address <br /> 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 corrections <br /> Operator's certification <br /> Inspection Date: September 26, 2018 Inspected By : ROBERT LOPEZ <br /> Facility Address: 1003 HUMPHREYS DR, STOCKTON CERS ID: 10186787 <br /> I certify under penalty of law that: <br /> 1 . I 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 A Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I 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: M ufu 0 I A Title: MA I & i E,u,4.,yGr Ma .yA4jK7k <br /> Signature: 12 Date: oc� l Zo18 <br /> 1868 E. Hazelton Avenue Stockton , California 95205 T 209 468-3420 i F 209 464-0138 1 www.sjcehd.com <br />