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08-08-'18 11 :36 FROM- T-945 P0001/0006 F-872 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue,Stockton, Califomia 95205-6232 <br /> Telephone;(209)468-3420 FaK:(209)468-3433 Web: sigoy-= <br /> 0 8 21 a 1 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> ENVIROMMENTAL <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be iiffP12� <br /> receipt of this Inspection. This certification form must be submitted to the Environmental Health Department(EHD)address. <br /> the top of this form within 30 days of receipt of the Inspection Report HSC 25404.1,2(c)(1) <br /> All gg[Lecbons 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 failing 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 crf the site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resufts/manffests/training records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: _.July 26, 2018 Inspected By: 9TACY RIVERA <br /> Facility Address: 3300 N WEST LN, STOCKTON CIERS 10: 10181477 <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 /> I believe the information to be true, accurate, and complete. <br /> Photos-��Paperwork L! Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent <br /> 4. 1 am ware that there are significant penalties for submitting false information, including the possibility of a fine and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: S--reu Title: <br /> Signature: Date: el cue 1 'F <br /> 4kaD� Vy-�� -qb� ONJ" COY 1eX 0'F "K"V74 ' AWIC-W""e <br />