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書塁SA岨」OAO旧字逗恵三　　coし」N丁Y <br />播ナ　G. 。…亘理「訂正五 <br />Envi ronmental Heal th Depa巾ment <br />RETURN TO COMPLIANCE CER丁IFICA丁! ON <br />A=y Mi NOR vi oi atfo=S nOted i = the “ Noti ∞ tO Compi y廿the attache d l nspecti on Report must be ∞汀ected w剛n 30 davs of <br />「ecei pt of帥s i nspecti on. Thi s certi fcati en form must be subm皿e d to the Envi ronmenfai Hea帆Department (EHD) add「ess at <br />the bottom oft両S form w軸i n 30 days of recei pt of the l nspecti on R eport. HSC 25404 1. 2(C)(1) <br />A= co「「ecti ons to othe「 vi oIati ons noted i n the attached l nspec ti on Report 0R) or Conti nuati on Form: or di SPuteS tO any <br />vi ol ati ons, are tO be submi tted usi ng帥s oert桶cati on and 「etume d to EHD w軸i n 30 davs unl ess othervi se speci fi ed l n the <br />l nspecti on Report. HSC 25185(C)(3) <br />Note: 　Ai ! EHD staff ti me associ ated w軸fa帥ng to compl y by仙e above noted dates wi ○ ○ be <br />bi =ed at the cu什ent hou「1y輪te, <br />For thi s ce面fi cati on to be compi ete, the operator o…e si fe mus t i ncl ude: <br />A statement documenti ng what ∞什eCti ve actl OnS Were taken o「 wi = be taken fo「 each vi ol ati on <br />Copi es of sampi e 「esui ts/mani festsItral ni ng 「e∞rds/othe「 app 「opri ate paperwork, and/or photos verftyi ng co什eCti ons <br />Operator’ s ∞輔cati on <br />1nspecti on Date: <br />Fac皿y Address: <br />J une O4, 2019 <br />1414-A W FREMON丁ST, STOCKTON <br />看nspected By: CHRi S丁INE LAWRENCE <br />CERSID: 　0 <br />Ice巾fyunderpenartyofl awthat: 1. 1havecorrectedthevi ol ati onsspeci fi edi nthel nspectionRepo巾fromtheabove-menti onedi nspecti ondate・ <br />2. i havepe「sona=yexami nedthefd州owi ngdocumentati onsubm皿ed asproofofcomp=an∞FOREACHVIOLATION <br />andl be=evethei nformati ontobet「ue, aCCu「ate, andcompi ete: 〇〇〇重ph。, 。S」蜜。。。v。「k】⊆sta, 。m。nt <br />3. 1amautho「i zedtosubmi tthi scerti fi cati ononbehal foftheRespondent. 4. Iamawa「ethatthe「earesi g=甫cantpenai ti esforsubm輔ngfai se i nfo「mati on, i ncl udi ngthepossi b掴tyofafi ne <br />and/o「i mp「j sonmentforknownvi oi ati ons. (HSC25191) <br />Nam。幽温色z. pI舘　　. , , 一。. OC9J v催LV_」 ○ s, 。nat。「。‥ 　　　　　　。。t。‥ 8-/G--/甲 <br />、繭曝 <br />1868 E H。Z。i t。nAv。nu。 I St。。kt。n, C。i , f。「ni a 95205 「 T 209論議o I F 209秘LO138 l ww ws」Cehd com <br />丁. 一,