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, � EnVironmental Health department <br /> JOAQUIN <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 tp other violations noted In the attached Inspection Report ( I R ) 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 wore taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> correctlons <br /> Operator's certification <br /> Inspection Date : March 04 , 2019 Inspected By : TRICIA DAI <br /> Facility Address ; 1350 REPORT AVE , STOCKTON CERS ID : 0 <br /> I certify under penalty of law that: <br /> 1 . 1 have corrected the violations specified in the Inspection Report from th© 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 J Paperwork _Statement <br /> 3 . 1 am authorized to submit this certlflcatlon on behalf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false Informatlbn , including the possibility of a fine <br /> and/or imprisonment for known violations - (HSC 25191 ) <br /> Name :_ V \rQVTA 41) N 59Y� Title : /TSS � s+` <br /> Signature : Date : r <br /> p `[� •�� i lit I� C ►1c 1/Vat I S Ah d ' �t. S te,5 wca t10 +- Wiahi` esf old so vie <br /> v✓ Vlcred. 05 � 1 be, sIJIe rece f"5 v � vJner� <br /> P <br /> MAR 2 0 2019 <br /> _ E <br /> DEPARTMENT <br /> R e c e 1 v e d T m e3LMa r : 2 0 . •tc2.01 9 , 2: 15 PM o ; 4 8. 1- 9rnia 95205 T 209 468-3420 I r 209 464-0138 1 www, sjoehd . com <br />