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Environmental Health Department <br /> SAN '..JOAQUIN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 39 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHp)address at <br /> the bottom 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 EHp 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 resultslmanifestsRraining records/other appropriate paperwork,andlor photos verifying corrections <br /> Operator's certification <br /> Inspection Date: May 28,2019 Inspected By: ELIANNA FLORIDO <br /> Facility Address: 2691 N Tracy Blvd,Tracy CERS ID: 10406356 <br /> I certify under penalty of law that: <br /> 1. I 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 and <br /> I believe the information to be true,accur ,and complete: <br /> photos--�t—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 penahies for submitting false information,including the possibility of a fine and/or <br /> imprisonment for known violations./(HSCI25191) <br /> Name: �1 01 Title: I �� <br /> Signature: Date:40 1 1 <br /> 1868 E.Hazelton Avenue I Stockton,California 95205) T 209 468-3420 1 F 209 464-0138 J www.sjcehd.com <br /> July 31,2019 pg.3 <br />