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SAN JOAQUIN Environmental HealtQ rceq� <br />APR 2 55�200118�� <br />ENVIROAWNT <br />RETURN TO COMPLIANCE CERTIFICATION PFRMIT/sFRWES <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 />Operators certification <br />Inspection Date: <br />Facility Address <br />19, 2018 <br />4555 N PERSHING <br />I certify under penalty of law that: <br />Inspected By: <br />JAMIE LIMA <br />STOCKTON CERS ID: 10183251 <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)K Paperwork Statement <br />3. 1 am authorized to submit this certification )r. 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: r4PrA&sV\ <br />Title: <br />*A -P JAC'� <br />Signature: <br />Date: <br />*)an\a <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 2094640138 1 www.sjcehd.com <br />