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SAN JOAQUIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Natter,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 at <br /> the bottom of this farm 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 Fomr,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless othemse spec'rfied 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 resulm/manifests/raining mcords/other appropriate paperwork,and/or photos verifying corrections <br /> Operators certification <br /> Inspection Date: June 25, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 3112 LOOMIS RD, STOCKTON CERS ID: 10181423 <br /> 1 cert'dy under penahy 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 VIOlAT10N and <br /> I believe the information to be true,accurate,and complete: <br /> __Photos Paperwork Stafiemenl <br /> 3. 1 am authonzed to submit this cartificafion 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/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: Milled- Title: �Ul.[Q. �2-iralPx— <br /> Signature: Date: �p��(, /I9 <br /> 1868 E. Hazelton Avenue I Stockton,California 952051 T 20946&34201 F 2094640138 1 www.sjcehd.com <br />