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S 'AN 0AQUIN Environmental Heafili I apartment <br /> RETURN TO COMPLIANCE CERTIFICATION <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 cedlf sfilOr form must be submitted Io the Environmental Health Department(EHD)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404-1,2(c)(1) <br /> All corrections to other violation_noted in Ire attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations, are to be submitted using this certification and returned to DID within 30 daya unless otherwise specified In the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EliD 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 ofthe este must include: <br /> A statement documenting what corrective actions were taken orwill be taken for each violation <br /> - Copies of sample results/manifestsbraining recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: May 15, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 3003 E HAMMER LN, STOCKTON CERS ID: 10181619 <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. I have personally examined the fallowing documentation submitted as proof of compliance FOR EACH VIOLATION and '.. <br /> I believe tho information to be true,accurate,and complete: '.. <br /> Photos X Paperwork X 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 passibility of a fine and/or '.. <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Jay SSwern Title: Plant Manager <br /> signature: C Date: June 13, 2019 <br /> 1868 E.Hazelton Avonuo l Stockton, California 85205 I T 209468-34201 F 209464-0138 I www.sjcalmeom <br />