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Parkwood Gas& Food 2098888157 p.1 <br /> 3 ��lb(iM�i;: <br /> N ' �!Q NEnvironmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violaGens noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 3d days of <br /> �Toeipt 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 violatiors noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this cerfiFication and returned to EHD within 30 days unless otherwise specified in the <br /> Inspeefion 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 violalon <br /> Copies of sample results/marifests1training recordslotherappropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: June 29, 2018 Inspected By: ZONA BARKER <br /> Facility Address: 1210 E HAMMER LN, STOCKTON CERS ID: 10181355 <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 f 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. t am aware that there are significant penalties for submitting false information,including the possibility o`a rine <br /> and/or imprisonment for known violations, (HSC 25191) <br /> Name: 1 C4,Y\ti Title: <br /> Signature: Date: !Z z`'f— t� <br /> RECEIVED <br /> JUL 2 5 2018 <br /> EWIRONMENTAL HEALTIJ <br /> PERMIPSERVICES <br /> 1868 E.Hazetton Avenue I Stockton,California 95205 I T 208 468-3420 1 F 209 464-0138 i www.sicehd•com <br /> Received Time Ju1. 25. 2018 10:46AM No- 3918 <br />