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San Joaquin County <br /> Environmental Health Department ..'; ; <br /> 1868 East Hazelton Avenue,Stockton,California 95205-6232 <br /> T ,hone:(209)468.3420 Fax.(209)468.3433 Webb:www. ov.o /rg ehd p` <br /> RETURN TO COMPLIANCE CERTIFICATION ' <br /> v .. <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 mays 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 corn tions 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 retumed 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 operatorof 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/manifestattraining reoordslottrer appropriate paperwork,and/or photos verifying <br /> corrections <br /> InWction Date: June 08,2017 Inspected Ry: ELIANNA FLORIDO <br /> Facility Address: 147 E LATHROP RD, LATHROP CER S IDA 10181421 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspeotion 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 flne <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: L&C= 7' Title: 2.rr'1"&C& <br /> Signature: Date: `•/1-/- <br /> 44AA- A,_jE__ dmoA <br /> 90010 39dd SAnoomi 9909898602 8t7:80 LIOZOLOOLO <br />