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SAN JOAQUIN Environmental Health Department <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 certification form must be submitted to the Environmental Health Department(EHD)address at <br /> the bottom of this forth within 30 days of receipt of the Inspection Report. HSC 25404_12(c)(1) <br /> All corrections to other violators noted in the attached Inspection Report(IR)or Continuation Forth,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 resultslmanifests/traming records/other appropriate paperwork,and/or photos verifying corrections <br /> Operators certification <br /> Inspection Date: July 15, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 2201 W WASHINGTON ST, STOCKTON CERS ID: 10182707 <br /> 1 certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentoned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and <br /> I believe the information to be true,accurate,and complete'. / <br /> PhotosPaperwork āœ“ 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 submithng false information, including the possibility of a fine antl/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: sfiR . Gt/NGGIC zāœ“ Title:j -- &~Wo^.0,1ll <br /> O1/ 9K <br /> .r <br /> Signature Date: 5 -, 21D/ 9 <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 wwwsjcehd.com <br />