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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: www,sogov.org/ehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR 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 at <br />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 violations, <br />are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report. <br />HSC 25185(c)(3) <br />All EHD staff time associated with failing to comply by the above noted dates will be billed at the <br />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 />Operator's certification <br />Inspection Date: December 13, 2018 <br />Facility Address <br />1 WINEMASTERS WAY STE D <br />Inspected By: <br />Claudia Muro <br />CERS ID: 10183687 <br />ander penalty of law that: <br />I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe <br />the information to be true, accurate, and complete: <br />otos Paperwork Statement <br />I am authorized to submit this certification on behalf of the Respondent. <br />I am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or <br />imprI <br />sonment for known violations. (HSC 25191) <br />Name: <br />Signat� <br />Title:.0/1.t /t <br />Date: /C/ <br />RECEIVED <br />I?NVIRONI\IENTAL tI[:AL"�1# <br />