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Environme'Rai <br /> 14 <br /> SAKJOAQUI <br /> C__0UNTY-­­­ <br /> ;,!4, Greatness (.Irowc here. SEB 2 6 2015 <br /> RETURN TO COMPLIANCE CERTIFICATION_ HEALTH <br /> t <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be corre&d,"v'Ai A:A'To &of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD) address; <br /> 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 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: January 30, 2018 Inspected By: CESAR RUVALCABA <br /> Facility Address: 2746 HEINZ ST, STOCKTON CERS ID: 10183341 <br /> 1 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 /> 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: (2 1 r4nk Title: ,e <br /> .4"901 ae <br /> Signature: 4&di AQA Date: iwanjo <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />