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1 <br /> `r nvironmental Health Department <br /> SAN 1OnQ �J1N I IN HEALTH'_ <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 <br /> at the top 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 withln 30 days unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Notes 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 <br /> corrections <br /> Operator's certification <br /> inspection Date : May 07 , 2019 WHOMMus- Inspected By: CLAUDIA MURO <br /> Facility Address : 17725 E HWY 26 , LINDEN CERS ID : 10182743 <br /> I 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 X-•—Paperwork x 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 <br /> and/or imprisonment for known violations. (HSC 25191 ) <br /> Name: c r� �l ~ s_� ��� Title: <br /> Signature: ' Date : 6 /: ' p / <br /> MOWN <br /> 1868 E . Hazelton Avenue j Stockton , California 96205 ( T 209 468-3420 ( F 209 4641.0138 1 www.sjcehd, com <br />