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S k N J O A Q u I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice.to Comply"In the attached Inspection Report trust 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. 'H5C 25404A,2{c}(1S <br /> All corrections to other violations.noted in the attached Inspection Report:(i R)or Continuation Form,or disputes to any <br /> violations, areto 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 resultslmanifestsltraining recordslother.appropriate paperwork,anal/or photos verifying. <br /> corrections <br /> Operator's certification <br /> .Inspection Date: April 10. 2019 Inspected By; LYDIA BAKER <br /> Facility Address: 11950 HARL.AN RD, LATHROP CERS ID: 10185013 <br /> 1 certify under penalty of law thaf <br /> 1. l have corrected theviolations.specifred in the Inspection Report from the above-mentioned inspection date. <br /> .2. I have personally examined the following documentation submitted as proof.af.compliance FOR EACH VIOLATION <br /> and I believe the.information to be true,accurate,and complete; <br /> Photos Paperwork " Statement <br /> 3.: 1 a authorized to-submit this certification on behalf of-the Respondent. <br /> 4. 1 aril aware that there are significant penalties for submitting false Information, including the possibility of a fine <br /> andlor imprisonment for known violations: (HSC 25191) <br /> Name:. n"JID Title:: 0=1TIC> v vey �������. <br /> 5ignature: Date: OV-30 -I C' <br /> 1868 E..HazeIWn Avenue j .Stockton. California 95?051 T 209 4ti8-3420 l F 2094.64-0138 <br />