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May.09.2016 12:25 PM W r1oo Liquors 20946 14 PAGE. 1/ 5 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone. (209)468-3420 Fax:(209)468-3433 Web:wwwA,gov.orWehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MI violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within MAW 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 IQ 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 d�m 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 /> Inspection Date: _A201 12, 2016 ,Inspected By: CINDY VO <br /> Facility Address: 2512 E WATERLOO RD, STOCKTON EPA Ia. <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 /> I believe the information to be true,accurate,and complete: <br /> Photos__Paperwork X/ 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 and/c <br /> imprisonment for known violations. (HSC 25191) <br /> Name: 6 v1 <br /> Signature: Date: <br /> MAY 0 9 2016 <br />