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ED ''IN AVQI ::E 81H 'SZ '130 awil paAI;3;� <br />Environmekt <br />SAN J6AQUINen <br />OCT 2 5 2018 <br />RETURN TO COMPLIANCE CERTIFICATION <br />-NVIRONMENTAL HEALTH <br />Any tNifVQR violations noted in the "Notice to Comply" in the attached inspection Report must be corrected SnJirlq �}m rT <br />receipt of this inspection, This certification form must be submitted to the Environmental Health Department (EMD) address <br />at the top of this form within 30 days of receipt of the inspection Report. HSC 25404.1.2(cx1) <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 YAOl e V 4@ unless otherwise specifed in the <br />Inspection Report. HSC 25185(c)(3) <br />'Note: AN 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; September 25, 2018 _ inspected By: <br />Facility Address: 245 W LOUISE AVE, MANTECA CERS 10: <br />I certify under penalty of Jaw that: <br />NICHOLAS LOEHRER <br />10183201 <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 compSance FOR EACH VfOLATtON <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. J am aware that there are significant penalties for submitting false information, including the possibi44ty of a fine <br />and/ori prisonment for known violations. (HSC 25191) <br />Name: 6�--. e. Title: <br />Signature:k-�W Date: / r <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd,eom <br />T /T —asiva Wd SV:0T STOZ-SZ <br />