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Jan 26 18 04:55p <br />p.2 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, Califom'a 95205-6232 g��p',, <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sroov org/ehd`i-. <br />RETURN TO COMPLIANCE CERTIFICATION Jk'11 2 6 2018 <br />Any MINOR violations noted in the 'Notice to Comply' in the attached Inspection Report must be c rrected'whhfn30�da�e of AL HEALTH <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address =HT <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 2511 <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 />Inspection Date: January 22, 2018 <br />Inspected By: ELIANNA FLORIDO <br />Facility Address: 4407 EWATERLOO RD, STOCKTON <br />CERS ID: 10180913 <br />I certify under penalty of few that: <br />I. I have corrected the violations specked 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___Lo�fpapenvork 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 know viplations. (HSC25191) <br />Name: »s7- Title: �ry '/' Cii �c <br />Signature: c=t I / Date: <br />U <br />