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kt c. X <br />FEB 1 19 2018 <br />San Joaquin County =� <br />D <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 f '" 3 L 018 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.c /� ehd <br />ENVIE'GTaIN,;�_;,� .�L HEALTH <br />RETURN TO COMPLIANCE CERTIFICAI DN DEPARTMENT <br />AnyIM NOR violations noted in the "Notice to Comply" in the attached Inspection Report mus le corrected within 30 days of <br />receipt of this inspection. This certification form must be submitted to the Environmental HeE i 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 Continuatior orm, or disputes to any <br />violations, are to be submitted using this certification and returned to EHD within 30 days unit s otherwise specified in the <br />Inspection Report. HSC 25165(c)(3) <br />Note: All EHD staff time associated with failing to comply by the abc a noted dates will be <br />billed at the current hourly rate. <br />For this certification to be complete, the operator of the site must incluc <br />A statement documenting what corrective actions were taken or will be taken for eacl Notation <br />Copies of sample results/manifests/training records/other appropriate paperwork, ant )r photos verifying corrections <br />Inspection Date: February 14, 2018 Inspected By: E ACY RIVERA <br />Facility Address: 10858 TRINITY PKWY, STOCKTON <br />I certify under penalty of law that: <br />CERS ID: 10186665 <br />1. 1 have corrected the violations specified in the Inspection Report from the above -men )ned inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of comp nce FOR EACH VIOLATION <br />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, includ 3 the possibility of a fine an <br />imprisonment for known violations. (HSC 25191) <br />Name: <br />Signature: <br />Title: <br />Date: <br />