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07 / 0312006 05 : 48 12699569632 STOCKTO PAGE 01 / 07 <br /> San Joaiquilil County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 9520M232 <br /> Tele Mone. (209 ) 465-3420 Fax , (209) 458-3433 Web: wwwusiaov.oralehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any ,N,nttuOR violation , noted In the '' Notice to Comply" in the attached Inspection Report must be corrected within Sod of <br /> receipt of this inspection , This ceriificstion form must be submitted to the Environmental Health Department (EHD) address <br /> the top of this form within 30 days of receipt of the Inspection Report, FISC 25404 . 1 .2 (c) ( 1 ) <br /> All corrections to other Wolations, 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 2518.ra(c ) ( 3 ) <br /> Nate : All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the currant 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/m anifests/training records/other appropriate paperwork , and/or photos verifying corrections <br /> Inspection Date : Mardi 25, 2019 Inspected By: STACY RIVERA <br /> Facility Address : _8606 THORN 'TON RP ,_STOCKTQN CERS ID : 10180975 <br /> ratify 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 . I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the informatlon 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 and/ <br /> imprisonment for known violations. (FISC 2"1191 ) <br /> Name: ' 0& �Title:_ <br /> ignatul'e: <br />