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I <br /> e <br /> i <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue , Stockton , California 95205 -6232JECI VED <br /> Telephone: 209 468-3420 Fax : 209 468-3433 Web : www. s ' ov. o I/e <br /> RETURN TO COMPLIANCE CERTIFICATION AUG 18 2017 <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report mustf'eW Wr6l telkj I►I 1 0f\ ba�i�Eof' LTH <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Deparfm_'4 t F.H11)'odd} ess <br /> at the top of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 142 (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 <br /> corrections <br /> Inspection Date : June 13, 2017 Inspected By : MICHELLE HENRY <br /> Facility Address , 7373 WEST LN , STOCKTON CERS ID : 10180977 <br /> certify under penalty of law that.- <br /> 1 . <br /> hat: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 /> 1 L l Photos 30 Paperwork C2 Statement <br /> 34 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 : TVl ( r4 Sk ,1 t,/Vj Title: Sct 1 d �c' ✓ roycS C <br /> Signature : � 2 ti(Ii , r a .�,1 ) Date: �� � / 17 <br />