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Mar.19.2018 12:37 PM 2092928113 PAGE. 1/ 3 <br />�V <br />�'��9��enlaalqhu <br />iena�Cm DSan Jo� <br />ep r, <br />�p <br />D <br />9?018 <br />88B East Hazelton Aenue,�e <br />11 Telephone: (209)488-3420 Fax: (209)490.3433 <br />We <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any �QR vloletions noted !n the "Notice to ComphJ' <br />In the attached Inspection Report must be cors (EBSL-`Ct1�D eddeye <br />receipt of this Inspection. This certification Corm must be submitted to the Envl25404..2 Health Department <br />et the top of this form within 30 days of receipt of the Inspection Report. H RC o��t nusUoo Form, or disputes to any <br />All --'^ ^'her violations noted in the attached Inspection Report (IR) unless otherwise specified In the <br />violotlons, are to be submitted using this certification and returned to EHD wilbh13-d`11 <br />inspection Report. HSC 25185(c)(3) <br />Note: All EHD Stafftime associated with falling 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 />r each <br />lation <br />documenting <br />what <br />COn cttIv ng rt" orrds/olher appropriate r will be taken o <br />opriate paperwork' andlorophotos verifying <br />Coulee of sample <br />corrections Inspected By: ROBERT LOPEZ <br />inspection Date: January 08 2018 <br />Facility Address: 1679 S <br />I certify under penalty of law that; <br />CERS 19: 0 <br />1, 1 have corrected the violations specifled in the Inspection Report from the above-mentioned Inspection date. <br />2, 1 have personally examined the following documentation eubmined as proof of compliance FOR EACH VIOLATION <br />and I believe the Information to be true, accurate, and complete: <br />Photos 2• Paperwork Statement <br />3. lam authorized to submit this certification on behalf of the Respondent, <br />4. 1 em aware that there are slgnhlcant penalties for submitting false Information, Including the possibility of a fine <br />and/or Imprisonment for known violatlons, (HSC 25191) <br />LX l 1 Ni QY I <br />f(lz I i� <br />