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Received on 04/11/2019 <br /> SJC EHD - CR <br /> SAN JOANIN Environmental Health Department <br /> CCLJN iV <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 <br /> at the top ofthis firm within 30 days of receipt of the Inspection Report, HSC25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Fon,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 ofine site must Induce: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifeststtmining records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: March 19, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 120 FRANK WEST CIR, STOCKTON CERS ID: 10184157 <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 following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information 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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: _ L I ,t. ♦ Trt1e: ,f�e,� <br /> �,/IZir �r <br /> Signature: c Date: <br /> 'i868 E. HazeftonAvanuel Stockton, California 95205 j T 209468-3420� F 209464-0138 www.sjcehd.com <br />