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0 San Joaquin County <br /> Environmental Health Department I� s <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 �� 3 <br /> Telephone: (209)468-3420 Fax: (209) 4683433 Web:www.sjgoy.orglehd 0 200 <br /> EWI <br /> RETURN TO COMPLIANCE CERTIFICATION PERM1� WHEoV <br /> ,ES <br /> �s <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be ccgrrected 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 25404.12(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 resultslmanifestsltraining records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: February24, 2017 Inspected By: STACY RIVERA <br /> Facility Address: 4800 S AIRPORT WAY, STOCKTON CERS lD: 10181439 <br /> 1 certify under penalty of law that: <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 /> PhotosPaperwork 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, including the possibility of a fine <br /> and/or imprisonment <br /> �nment for kno�lations. (HSC 25191) <br /> Narne- D ZTitle: �, -� r. d a 5 v r- <br /> 41 C L7 <br /> I Date_ c 6 / 7 <br /> JJ ++ C Q rP_. rr % //+v'� �D > <br /> ��� C'o 01'e 4e LP P 0 d,- P �,P <br /> J 'I-Ne <br /> LODr <br />