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SAN OAQ 1V U I N Enviro ii ;i epi+ ent <br /> ( Y <br /> 1T FEB 2 1 2019 <br /> ONNMMFNTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICA� IO IAF I] AEP 4T <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected 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 . 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 : January 11 , 2019 Inspected By : CESAR RUVALCABA <br /> Facility Address : 809 SNEDEKER AVE , STOCKTON CERS ID : 10186957 <br /> I certify under penalty of law that: <br /> 1 . I 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 : Ow 402r4 ,&jl,L2,�GG/.dii tom/ Title :���,d�ilr!= <br /> Signature . Date : A 10IV <br /> 1868 E . Hazelton Avenue ( Stockton , California 95205 T 209 468-3420 i F 209 464- 0138 1 www . sjcehd . coni <br />