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06/14/2017 23:52 2098585066 TWOGUVS PAGE 01/01 <br /> t - <br /> San Joaquin CountyR E <br /> Environmental Health Department ED <br /> 1868 East Hazelton Avenue,Stockton,California 95205.5232 <br /> 7'elWhane:(249)468-3420 Fax:(209)468-3433 web:www.slQov.orst/ehd U N 5 2017 <br /> 6„L�- <br /> RETURN TO COMPLIANCE CERTIFICATIC�Vz���„���UPpM�Q���TA► HEALTH <br /> 1'uaysrdT” <br /> Any MING,R violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within `df' I�E N <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(cX 1) <br /> All correction%.�g1her Xipj0jlpns 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 dates 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 resultstmanifestsltraining records/other appropriate paperwork,and/or photos verifying <br /> corrections <br /> 'Inspection Date: June 08, 2017 Inspected By: ELIANNA FLORIDO <br /> Facility Address: 147 E LATHROP RD, LATHROP CERS ID: 10181421 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specrfiad in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personalty 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 cartific ation 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: C7" Title: <br /> Signature: Date: -7 <br /> "OVA A)4AA, <br /> /!pit''- aO <br /> p96Z3Z3S-3 FAoaaPS 66 <br />