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07-15-' 19 15 : 49 FROM- 12094626171 T-023 POOO1 /0002 F-078 <br /> C . .?ir'?<i :>�::isa:; :•,:'�:':': `<("�iiGii� :. ;i? ii 'i: :i%'";� . <br /> �ed ' u II 4 l Environmlental Health Department <br /> did <br /> nt, � A � > AVIM . <br /> ih ' ti4Ea`: <br /> s":rCSis, , .. . . . , i';' a ? :. > , i;i'.. . . . . . . .. . . ... . . <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 at <br /> the bottom of this form within 30 days of receiptof the . lnspection 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 : July 02 , 2019 Inspected By : STACY RIVERA <br /> Facility Address : 3300 N WEST LN STOCKTON CERS ID : 10181477 <br /> I 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 and <br /> I believe the information to be true, accurate , and complete: <br /> Photos Paperwork Z__ atement <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 and/or <br /> imprisonment for known violations , (HSC 25191 ) <br /> Name : �}Sr� dd Title: <br /> Signature _ Date = � ' ► r` 1`� <br />