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i SAN I Environmental Health Department RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the`Notice to Comply'in tie attached Inspection Re.)ortmust be corrected within 30 days of receipt of this inspection. This certification form must be:submitted to the Environmental Health Department(EHD)address at the bottom of this form within 30 days of receipt of the Inspection Report. HSC 254C4.1.2(c)(1) All corrections to other violations noted in the attached Im pection Report(IR)or Cor tinuation Form, or disputes to any violations.are to be submitted using this certification and returned to EHD within 30jays unless otherwise specified in the I I Inspection Report. HSC 25185(c)(3) Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. I For this certification to be complete, the operator of the site mr,st include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training recd;ds/other appropriate paperwork, and/or photos verifying corrections Operator's certification Inspection Date: October 03, 2019 Inspected By: LYDIA BAKER Facility Address: 5463 E CHEROKEE RD, STOCKTON — CERS ID: 10182553 I certify under penalty of law that: I 1. 1 have corrected the violations specified in the Ir spection Report from the above-mentioned inspection date. 2. 1 have personalty examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true,accurate, and complete: X Photos X Paperwork X Statement 3. 1 am authorized to submit this certification on bohalf of the Respondent. 4. 1 am aware that there are significant penalties f:)r submitting false informa ion, including the possibility of a fine and/or imprisonment for known violations. (HS(:25191) Name: Jerry P Cardoza Title: Inventory Control Specialist Signature: Date: -- I i I 1 i