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08/02/2018 10:2? (FAX) P,002/065 <br />SANtJOAQUiN <br />------COUNT Y,._ - <br />` Groorness grows here. <br />Envlronmental Health Department <br />ECEIVED <br />RETURN TO COMPLIANCE CERTIFICATION AUG 0 2 2018 <br />N V I R r, MENTA L <br />Any MINOR violations noted in the "Notice to Comply" In the attached Inspection Report must be corrected within 30 day9 of :. A RTIMENT <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 />All corrections to other violations noted 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. HSC 25185(c)(3) <br />Note; All EHD staff time associated with falling to comply by the above noted date$ 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 results/manlfests/training records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certification <br />Inspection Date: July 02 2018 Inspected By: LYDIA BAKER <br />Facility Address: 1645 CHEROKEE RD, STOCKTON CER$ ID; <br />I certify under penalty of law that: <br />10181309 <br />1, 1 have corrected the violations specified in the Inspection Report from the above-mentioned Inspection date. <br />2. 1 have personalty 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 />Signature: <br />Title: o r� <br />"JADate: 7 <br />if IF <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd,com <br />