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SAN ,J O A Q U I N Environmental Health DJatment <br /> Y <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 /> All corrections to other violations noted in the attached Inspection Report(IR)or Continual, ;or`disputes <br /> violations,are to be submitted using this certification and returned to EHD within 30 days ptherwise specified in the <br /> Inspect;c,-�Report. HSC 25185(c)(3) t <br /> 4'`S44w <br /> .- <br /> dote: All EHL)staff time associated with failing to comply by the above noted slates will be } <br /> ill d at the current hourly rate. o <br /> Oi fi�!is certl7ica`rioiri 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 /> " yI <br /> Copies of sample resui,simanifests training recordsiother appropriate paperwork,and/or photos I' <br /> Operator's certification <br /> specfion Date: Januati 29, 20T s <br /> Inspected By. ZUNA BARKER <br /> acilit,%i t Or r ss: 2575 COUNTRY"CLUB BLVD, Stockton CERS ID: 10118074 <br /> Me 11-9evan"?dpc ' om7772777677mention,777 pectinr date. <br /> .. pe,'�;unally exarnined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> a^c,br:':eve the infcrrnation to be true accurate,and complete: <br /> Photos_ Paperwork Statement <br /> t to submit this certification on behalf of the Respondent. <br /> at,aroahat <br /> the re^re significant pens.0e .s forubrrittingmise information,including the possibility of a fine <br /> arsmpaisanmentforknown violations, (HSC25191) <br /> 8lT]c: <br /> Title:T <br /> Date _ <br /> %o <br />