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SAN OAQUIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> %i 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 farm must be submitted to the Environmental Health Department(EHD)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(,)(1) <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form,ar disputes to any <br /> violations, are to be submitted using this cerblicadon and rat,mcd to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(,)(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 /> Forthis certification to be complete, the opemtorofthe site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Operator's certification <br /> Copies of sample results/manifests/training records/other appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: November 18, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 7000 S INLAND DR, STOCKTON CERS ID: 10183461 <br /> Fcertify under penalty of law that: <br /> 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the informalion to be true,accurate,and complete: <br /> _Photos paperwork. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting fals information,including the possibility of a fine and/or <br /> imprisonm for wnvio fiq a. (HSC25191) <br /> Name: 1t <br /> Signature: Dat Dat 1 <br />