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ATTACHMENT B <br /> N.rlHQ��N Environmental Health Department <br /> �f 4 <br /> ---COUNTY - <br /> �Jrfyw� 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 tie top of this form within 30 days of receipt of the Inspection Report. HSC 254041 2(c)(1) <br /> 3 <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 /> I <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 resultslmanifests/training recordslother appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: Januaryll, 2019 Inspected By: JASON GAITAN <br /> Facility Address: 450 E YOSEMITE AVE, MANTECA CERS ID: 10182385 <br /> 1 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 <br /> and I believe the information to be true, accurate, and complete: <br /> 3. I am authorized to submit this certificatfon on behalf of the Respondent. <br /> 4. l 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 /> f, Z/D 3 - Pu_7 CC01,;� 7p%r. 1 <br /> I ll e� /.o-&eL a"I <br /> 4. 4 o/:' Ye 9-al/au eP,1, T.c �� + 0*1 P/&7'e <br /> 3 - n G Tek-&k e r 'In r^s . A-1 0 4a,cl, SA e 1,- 11t s,,d <br /> i0 qa E/e,.1 u5ed 5wW 6L,57' <br /> PA e <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 i www,sjcehd.com <br /> 4 <br />