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01/24/2017 14:04 2093675424 BACLEY ENTERPRISES PAGE 01/02 <br /> AmkAdlk <br /> San Jo"uln County <br /> Environ al Health Depeftent RECEIVED <br /> I M East Hazelton Avenue,Stockton, California 96206-6232 <br /> Telephone:(209)468-3420 FhK:(209)468-3433 Web:MftaigmwW&hd J AN 2 4 2017 <br /> RETURN TO COMPLIANCE CERTIFICAMQkNMENTAL HEALTH <br /> DEPARTMENT <br /> AnyMItQ13 violations noted in the"Notice to Comply"in the attached Inspection Report must be cflrr whhin_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 /> AN Miol to Q1baL-vWgLQM 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 EMP within IQAM 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 of the site must indude- <br /> • A statement documenting what corrective actions were taken or vWQ be taken for each Violation <br /> Copies of sample resuftfteriftsts/training recordslother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Ins etion Date: Janus!y231-2017 Inspected By: ELENA MANZO <br /> Facility Address; 7000 N MICHAEL CANLIS BLVD, FRENCH(CERS ID: 10181419 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-marytioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH 1/1 TION <br /> and I believe the Information to be true, accurate,and complete; <br /> Photos--Paperwork—� Sutement <br /> 3. 1 am authorized to submit this certification on behalf of the ReWndent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, Including the possibility of a fine <br /> and/or i risonment fork violations, (HSC 25191) <br /> Namer--�� V, nla-Kl? TA I e: <br /> Signa Date;, <br />