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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.skjov.oro/ehd <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 be submitted to the Environmental Health Department (EHD) address: <br />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 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 EHD staff time associated with failing to comply by the above noted dates will be billet <br />at the current hourly rate. f <br />For this certification to be complete, the operator of the she must Include: <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />Copies of sample results/manifests/tralning records/other appropriate paperwork, and/or photos verifying corrections <br />Operator's certification <br />Inspection Date: August 21, 2019 <br />Facility Address: 7835 S Inland Dr <br />I certify under penalty of law that: <br />Inspected By: Cesar Ruvalcaba <br />CERS ID: 10484737 <br />1. 1 have corrected the violations speclfled 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 <br />I believe the Information to be true, accurate, and complete: <br />_Photos _Paperwork X Statement <br />3. 1 am authorized to submthis certification on behalf of the Respondent, <br />4. 1 am aware t th significant allies for submitting false information, including the possibility of a fine and/o <br />impris on f nownviolati . (HSC25191)11/ <br />Name: Title: �` &L�� WC, ,a,C✓ <br />