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07/02/2013 19:56 510796''170 SHARMA PAGE 03 <br /> ...0 ss..... .. <br /> li, a yt= Environmental Health Department <br /> 4 <br /> X.r <br /> tVED <br /> MECEI <br /> RETURN TO COMPLIANCE CERTIFICATION JUL 0 s 2018 <br /> '=NVIRONMENTAL_ <br /> Any MINOR violations noted In the`Notice to Comply"in the attached Inspection Report must be corrected withip ! 'PARP/1ENT <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD ddress <br /> at the top of this form within 30 days of receipt of the Inspection Report. Mit;;2b4u4.1,.2(c)(1) <br /> All rorrtrZions 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 /> Inspectlon Report, HSC 25165(c)(3) <br /> Note: All EHD staff time associated with falling 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 results/manifests/training records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: June 05, 2018 Inspected By: ZUNA BARKER <br /> Facility Address: 1711 E Yosemite Ave,Manteca CERS ID: 10422475 <br /> 1 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 I believe the information to be true, accurate,and complete: <br /> Photos_Paperwork_ � 1 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. (HSC 25191) <br /> Name: KO L OEEP _ SK O M h Title: � Q <br /> Signature: 4 "00 Date; <br /> Received Time Jul, 2, 2018 9 ;45PM No, 3804 <br /> 1868 E-Hazelton Avenue I Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />