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Dec , 27 , 2019 10 . 43AM No , 1487 P . 9 <br /> Environmental Health Department <br /> SALMON <br /> ' F, r " VIP' ' Grcomess grows here, <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the Notice to Comply° in the attached Inspection Report must be correrte within 30 days of <br /> receipt of this inspection , This certification form must be submitted to the Environmental Health Department (FHP ) address at <br /> the bottom of this form within 30 days of recelpt of the inspection Report. MSC 25404 . 12(c)( I ) <br /> All corrections to other violations noted In the atteohed Inspection Report (IR) or Continuation Form , or disputes to any <br /> violations , are to be submitted using this certificatlon and returned to EH0 within 34 dans. unless otherwise specified In the <br /> Inspection Report, HSC 25185 (c)(3) <br /> Note: All I= HD staff time associated with failing to comply by the above noted dates will be billed <br /> at the current hourly mite, <br /> For this certification to be complete , the operator of the site must Include: <br /> A statement documenting what corrective actions were takers or will be taken for each violation <br /> Copies of sample results/manlroots/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operators certification <br /> Inspection Date . December 05 , 2019 inspected Sy: LYDIA BAKER <br /> Facility Address : 3301 N NAVONE RD , STOCKTON CERS ID : 10182189 <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 /> and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 1 1 am authorized to submit this csrti fication 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 <br /> and/or Imprisonment for�kn-o'w"n violations , (MSC 25101 ) <br /> Name: 1 Title :.7 f ie ,_. d� Vk <br /> Signature : c-- '" Date: ! "3 <br />