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NA <br /> l Environmental Health Department <br /> C:QLliili-Y- <br /> RETURN TO COMAPLIANCE CERTIFICATION <br /> AN MilyDR vkarahons noted m/ic'Naiiba bDCarnply'In me enrhod Inspeeliam Report must be cu "e dwehin 30 love of <br /> rmwilA 4f this irpedfan.This 4enificoip-form mrBt he mbmhtedto tha Envkanmtnkel Fleallh Departrmml(EH D)addrew 0 <br /> lhatot.pm d this fb"wINn 30 deys o m=v of tM Ir-ne'210n RepafL tf6C 2W4.1.2[t�1 j <br /> Al=Twlionsia ethos loWlinlM A(ted Ir the atbchcd irapediarl Report[IR)or O ntinualim pane,wdiapuiea to any <br /> vlc%doro.am to ha-N-rithrJ using tsrla cai'dicatim pnd noLened is EHD aptciriea in Me <br /> Inepedlon Rep[c1. HSC 251 B5 3W <br /> Note; All EHD staff time afs4olated with fedllr![to comply by the above noted dem®will be <br /> lailled at the curront 1 allAdy rate, <br /> For this certification to be complete,rh.ap—ideariheeirsmust includo: <br /> A eta.lerrant do%rnamlin3wh.2t mueothm eallenr wm taken or will b4 taken for each valatim <br /> Copesaisample reeuWmanifasls'lrainrngmia tlsfelher3pprcpnatapepenwork,an0o-yhcC4ver6l"tarreadaro <br /> Opareinrs—ifi-ban <br /> Inspectlon date: flay 16,2019 InSpeetrad BY: CLIANHA FLORIDO <br /> FaWiltyr Addra®e: 1365 E Yosernite Ave,hlarrtese CERS ID: 1N03350 <br /> I cerPFy urder panahy of ktirihdll <br /> I h;wc-rr^dkd%lvldahone sPwifled n the inspccWn Roertfretr the ebove-rnenEorod insM-O-n dale. <br /> 7-. I hpvy parsanallyerarained thefD%Avlrtg dowm"vfnn w1:—lmd as proof d aamptanco FOR EACH MLATION and <br /> I heheyetha Inform4on to 6ptruc,acturata,rnd ocmple6e: <br /> Pholw Paprn—rk 5191ement <br /> 3, I r ajihorizea M suM11t1Ia(mit6uelion on hchalf of:he Reepancinnl. <br /> q, 1 pm owam thzF ihwn afeagnlflrmnt penaldee for aubrnitOng palsy infoprLA0.i1dutliio:la pecslUilty of a-Ina andMr <br /> tnprleormentcrknaL ++c71¢iicns. {HSC 25191} <br /> i <br /> Name: r d& Title: f (OaL)+ <br /> Signature: Late_ 1 <br /> 1866 E Hamlin,Ayenee f Stodalon.Cai ernia 9521,5I T 209 488-3320 I F 209 434-0138; www-5ltehtl.cara <br /> July 23,2019 pg.2 <br />