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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.siaov.omlehd <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 he 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 violatl n 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 34 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 resullslmanlfestshraining recordstolher appropriale paperwork,andlor photos verifying <br /> corrections <br /> Inspection Date: April 09,2419 Inspected sy: ELIANNA FLORIDD <br /> Facility Address: 1209 E March Ln, Stockton CERS ID: 10457985 <br /> I certify under penalty of law that: <br /> 1. I have corrected the vlolations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOIa4TI0N <br /> and I believe the informalion to be true,accurate,and complete:---L <br /> V/Photos Paperwork � Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penallias for submitting false information,including the possibility of a fine + <br /> andlor imprisonment for k own violations. (HSC26191) f (�J <br /> Name: �" Title:4 <br /> ��r CSN <br /> Signature. L Date: 1 _,10 <br /> May 15,2019 pg.3 <br />