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11 - 16 - 18 ; 08 , 04AM ; # 1 / 2 <br /> ANwn AHEnvironmental Health Department <br /> I Alm <br /> � C O U N T Y � <br /> Greotness grows here. <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 of this form within 30 days of receipt of the Inspection Report, HSC 25404, 1 .2(c)( 1 ) <br /> Ail c9rrections _toether viola#ionsnoted in the attached Inspection Report (IR) or Continuation Form, 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, MSC 25185(c) (3) <br /> Nate: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> Ve <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 results/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> f t 1 <br /> inspection Date: October 17 , 2018 Inspected By: TRICIA DAI <br /> Facility Address: 3800 W COUNTRY CLUB BLVD , STOCKTON ClRS lit ; 10180907 <br /> I certify under penalty of law that: <br /> 1 , 1 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 VIOLATION <br /> and 1 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, I am aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations, (H$02$ 191 ) <br /> Name , �.: ( ( 0 = Title' *eri /V <br /> Signature: AZ4 Date: <br /> v <br /> i , <br /> rF, � <br /> 5gg <br /> 1888 E, Hazelton Avenue ( Stockton, California 952051 T 209 468-34201 F 209 464.0138 1 www,sjoehd. com <br />