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Environmental Health Department <br /> SAN )OWIN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the'Notice to Comply'in the attached Inspection Report must be corrected withm 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 form within 30 days of receipt of the Inspection Report.HSC 25404.1.2(c)(1) <br /> All corrections to other v dations 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 /> r <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 billed <br /> 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/manifeststtraining records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> 1 <br /> Inspection Date: December 23,2019 Inspected By: JOHN ALANIZ <br /> Facility Address: 948 W Charter Way,Stockton CERS ID: 10182425 <br /> 1 certify under penalty of law that. <br /> f 1. 1 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 /> X Photos �0 Paperwork X 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 pbasibWV of a Ana <br /> and/or Imprisonment for known violations.(HSC 25191) �^ <br /> Name: VAL-'- �^X 9 Title: <br /> Signature: Dale. <br />