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1N3Wladd3a <br /> l-Id3H Jd1N3WNObIAN3 <br /> S Q N J 0 a U N �0k*onmental Health Department <br /> _ . - c o u NI r Y a� Al <br /> '� 141lFes•� Greatrie .5i grows here , <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 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 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 documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : May 28 , 2020 Inspected By : SHEWIT WOLDEAREGAY <br /> Facility Address . 10878 N HWY 99 , STOCKTON CERS ID : 10180717 <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 . 1 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 . ( HSC 25191 ) <br /> Name : AJ Title : v��9 . ✓ <br /> Signatur . Date : 2 3 \ Lo <br /> J��pO QP <br />