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SAN JOAOUIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any Poll NOR violations noted in the -Notice to Comply-in the attached Inspection Report must be corrected within 30 davc of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Heath Department(EHD)address at <br /> the bottom of this form wthin 30 days of receipt of the Inspection Report. HSC254041-2(c)(1) <br /> All r 6 1 th tat' noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations, are to be submitted using this cmbfication and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report, HSC251a5{cl(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 inciude <br /> Astatement documenting whatcorrectvc actions were taken or will be ul for each violation <br /> Copies of sample resulls/manifeststtraining recordeVother appropriate paperwo•k,andror photos verifying corrections <br /> Operator's certification <br /> Inspection Date: September 09, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 19500 CLIFTON COURT RD, STOCKTON CERS ID: 1018_5643 <br /> 1 certify under penalty of law that <br /> I_ I have corrected the violations specified in the Inspecbon Report from the above-mentioned inspection date. <br /> 2 1 have personally examined the following documentation submitted as proof of rnmpliance FOR EACH VIOLATION <br /> and I believe the information to be true.accurate,and complete. <br /> Photos � Paperwork /tatement <br /> 3. I am authorized to sebm@ this certificabw on behall of the Respondent. <br /> C lam aware that there are significant penalties for submitting falx mWmalim. including the passibility of a fine and', <br /> imprisonment for known viylabo s. (HSC 25191) <br /> l K <br /> Name d Title: Eyguoy--�; <br /> Signatur _ Date: <br />