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SAN JOAOUIN Environmental Health Department <br /> C OUNiV <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 at <br /> the bottom of this tone 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 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 of the site must include: <br /> A statement commenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/traming records/other appropriate paperwork,and/or photos verifying corrections <br /> Operators certification <br /> Inspection Date: May 19, 2020 Inspected By: GARRETT BACKUS <br /> Facility Address: 61 Stork Rd, Stockton CERS ID: 10721335 <br /> 1 certify under penalty of law that <br /> 1. I 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 /> _Photos Paperwork ✓ 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 possibility of a fine and/or <br /> imprisonment for known violations. (HSC25191) 1 <br /> Name: nZZie C1onle7- <br /> Tiger' f.�✓y"1 MWl1Gtg21/ <br /> Signature:0, �- � Date: ��H/20 ZD <br />