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Elm <br />r1, , . M <br />San Joaquin County MAR 13 2017 <br />Environmental Health Department <br />1868 East Hazelton Avenue Stockton California 95205.6232 <br />Telephone: (209) 468-3420 Fax: (209) 468.3433 Web: VAIAv S'NMENTAL HEALTH <br />DEPARTMENT <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any PAINOR violations noted in the 'Notice to Comply' in the attached Inspection Report must be corrected v;ithin 30 days of <br />receipt of this inspection This cert:fcation 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 />Ali correct onsto 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 yYithin 30 days unless otherviise 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, t operator of the s to must inclu:;: <br />A statement documenting what corrective actions were tal,,en or Plitt be tat, -n for each viJl `.,-.. <br />Copies of samp!e resu!tslmanifes! 3 ning records/other appropriate paC::'-;':ork, and'oi -, veriiyin <br />corrections <br />Inspection Date: October 31, 2016 Inspected By: MICHELLE HENRY <br />Facility Address: 15999W CORRAL HOLLOW RD, Tracy CERS ID: 10154767 <br />i cer t:fy undar pen:i !y of lav; that <br />1 I have corrected the vioIntfon: F , , -. _.;-ton Report from above ment oned Inspection d3t_ <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 compiete <br />a!tt'r.Dr._?J t;7 SLl?:nlli if7l rti°C=i., Cri Lie it7if t'ii. <br />�., _... t'i3'. tri{ _.., � 3;1 C,_ - t _f� . , �� f'J! S'Jt•r?'�f; ri �1 13'- �,, r�. _.'i'i�' G( '(�.!'t.l i'.7. 1 � ['� _ t t r . . . <br />Name Frances Alston, Ph.I). ;1i ES&H I)irector <br />SignaturenC�,�U� , �-- Date -� �I 17 <br />