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San Joaquin County <br />EOvPDODl8Ot8|Hee0l��p8dDl�Dt <br />' <br />1O68East Hazelton Avenue, Stockton, California Q52U5-6232 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sffiqov.org/ehd <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />receipt ofthis inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />atthe top ofthis form within 3Odays cfreceipt ofthe Inspection Report. HSC 25404.1.2(c)(1) <br />All corrections to other violations noted inthe attached Inspection Report (|R)orContinuation Form, nrdisputes hzany <br />violations, are tobesubmitted using this certification and returned toEHD within 30 days unless otherwise specified inthe <br />Inspection Report. HSC 25185(c)(3) <br />Note: All EIHD staff time associated with failing to comply by the above noted dates will be <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 naoondo/otheropprupriate papemvork, and/or photos verifying <br />corrections <br />Inspection Date: July 19, 2018 <br />Facility Address: 431 SPERRY RD, STOCKTON <br />InsBy: JOHN A[ANIZ <br />I 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 />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, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: Title: <br />Signature: Date: <br />