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i <br /> g= N Environmental Health Department <br /> SANJOAQUIOUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIQ 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 j <br /> violations,are to be submitted using this certification and returned to EHD within 3g dans unless otherwise specified in the ! <br /> Inspection Report HSC 25185(c)(3) r <br /> I <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be E <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 1 <br /> Copies of sample results/manifests/training recordstother appropriate paperwork, and/or photos verifying I! <br /> corrections - I <br /> Operator's certification <br /> Inspection Date: July 31, 2018 Inspected By: AARON HANG <br /> Facility Address: 2501 JACKSON AVE, ESCALON CERS ID: 10181511 <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 /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> i <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: V'2-,c V�cNTitle: 0�2 f-f-aV,(Y, <br /> Signature: ( 4 ; � .� y.1'�f Pe , ate: <br /> t <br /> 1868 E.Hazelton Avenue Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com i <br />