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RECEIVED <br /> SAN 10AQUIN <br /> JUL 2 F3 2019 Environmental Health Department <br /> • <br /> ENVIRONMENTAL. <br /> HEAITH nPDIIPTMIPPNj <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOB 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 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 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 corrections <br /> Operator's certification <br /> Inspection Date : June 05 , 2019 Inspected By : ELIANNA FLORIDO <br /> Facility Address : 14700 W SCHULTE RD , TRACY CERS ID : 10153919 <br /> I certify under penalty of law that: <br /> 1 . 1 have corrected the violations specified.in the Inspection Report from the above-mentioned inspection date w • t k f he <br /> 001 t-4- 5t4 ^% � 14 C; Z c, 63 (�K -it C)$ . JTC4 > <br /> 2 . 1 have personally examined the following documentation submitted as proof of compliance and <br /> I believe the information to be true , accurate , and complete: <br /> Photos '�Paperwork `� Statement <br /> 3 . I 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 and/or <br /> imprisonment for known violations . ( HSC 25191 ) <br /> Name : OR tol GRA /JA DOC, Title : �?C.A/JT fcl A/ AGEK <br /> Signature : Date : `l 119 < 19 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-34201 F 209 464-0138 1 www. sicehd . com <br />