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S A N J OA Q U I N Environmental Health Department <br />COUNTY <br />RETURN TO COMPLIANCE CERTIFICATION Z�ifl <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected,within•30-days of;'i,j!�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 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 />Operator's certification <br />Inspection Date: September 27, 2018 Inspected By <br />Facility Address: 1477 TILLIE LEWIS DR, STOCKTON CERS ID <br />I certify under penalty of law that: <br />CESAR RUVALCABA <br />10183659 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. I 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 Paperwork _Statement <br />3. I am authorized to submit this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitt <br />ing false informatio <br />1n, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) A 27 1), <br />ame: � Title:_ ft,+ • mw <br />Signature: <br />ate: I fl• 3 c• 1 8' <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 (F 209 464-0138 � www.sjcehd.com <br />