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:2 <br />S A N.PJ 0A 0 U I N Environmental Health Department <br />`•��;. —COUNTY <br />r4cr Greotness grows here. <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 />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 violations noted in the attached Inspection Report (1R) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EMD 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 results/manifests/training records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Operator's certification <br />Inspection Date: February 19, 2019 Inspected By: <br />Facility Address: 705 INDUSTRIAL PARK DR, MANTECA CERS ID <br />I certify under penalty of law that: <br />LYDIA BAKER <br />10184415 <br />1. 1 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 <br />and I believe the information to be true, accurate, and complete. <br />Photos X 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 penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: V ' �IJ� Title: <br />Signature:-C"Date: _ 32o20 <br />F6pLAR� �s �� sow -rnk-i 7 e y�4pn <br />o�' -L- S t5 s IJ ro 43Y tC J1=s .�l�Q--I -e- 0 <br />(4j7 LL_ t3E [6,C -P7 <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />