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%M 11/07/2018 13.3J 2093589756 CEN CAL PLASTERING PAGE 01/05 <br />■ ■ <br />■ <br />■ <br />■^-`��� Environmental Health Department <br />■ry■ ., t J SAF:A0 <br />Yr• V l' ■t Y.YM <br />ahe�y��u i�;,'! : • .: f'�,'1+d.CX�E�'�i S.. i�`�t'O Vr'3 .: �1'C;r�, <br />RETURN TO COMPLIANCE CERTIFICATION 7 2018 <br />/lno N4 ENTAL <br />AnyIM NOR violations noted in the "Notice to Comply" in the attached Inspection Report must be correctQd within 3o days of rc'.-!77"`A ENT <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 othsr 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 day§ 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: March 07, 2018 <br />Facility Address <br />Inspected By: NICHOLAS LOEHRER <br />15300 S MCKINLEY AVE LATHROP CERS ID; 10184285 <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 fallowing 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 posslblllty of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: %r - Title: <br />Signature: - Date: <br />1868 F. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 i F 209 4640138 1 www.sjcehd,com <br />Received lime Nov, 7. 2018 12:01PM No. 4372 <br />