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V t l Environmental Health Department <br /> SANIN <br /> y�.+C 0 U hal T Y­­ <br /> Y'r <br /> rear e�,u glows hetC4, <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 <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 <br /> violations,are to be submitted using this certification and returned 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 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 <br /> corrections <br /> Operator's certification <br /> Inspection Date: January 22, 2019 Inspected By: TRICIA DAI <br /> Facility Address: 3333 S HWY 99 , STOCKTON CERS ID: 10182035 <br /> 1 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 /> XPhotos 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 fine <br /> and/or imprisonm for kn n violations. (HSC 25191) <br /> Name: fir" 1 C'/121'/Z ,p <br /> Signature: Date: <br /> Robert Bumgardner <br /> General Manager �� MACS®K <br /> and Service Manager II:RjTTi7:1;>tl <br /> Western Truck Center A Tayola Group Company <br /> 3333 S Hwy 99 W Frontage Rd. D: (209)323-7321 <br /> Stockton,CA 95215 T. (209)323-7300 <br /> rbumgardner@wtpe.com C: (916)850-9774 <br /> www.wtpe.com F: (209)323-7329 <br /> Redding•Stockton•West Sacramento <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />