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i . I SANi Environmental Health Department ,t_ U NTY- RETURN TO COMPLIANCE CERTIFICATION 5 i Any MINOR violations noted in the°Notice to Comply' in the attached Inspection Report must be correct thin 30 d of receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EH D)address at the hottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) , All s to of ' lafion noted in the attached Inspectioh Report(Ifs) or Conti nuatlon Form, or disputes to any violations, are to be submitted using this certification and returned io EH withbi3 days uniess otherwise specified in the In*ec kOon Report. HSC 259 85(c)(3) Mote: All EH staff time assoclated wlth failing to comply by tyre above noted dates gill be killed at the current hourly rate. For this certification to be complete, Lbe operator of the sits must include: A statement documenting what correiAve actlons were taken or will be Liken for each violation Copies of sample resultslmanifestaAraining recordsloth�r appropriate paperwork, andlor photos verifying corrections Operator's certification Inspection Date: September 01, 2020 Inspected By: ROBERT LOPE Facility Address: 343 E MAIN ST STE8'17, STOCKTON GER ID: 10145381 1 certify under penalty of law that: 1, I have corrected the violations specified in the Inspection Report from the above-menUoned inspection Gate- 1 havia personally exarnined the following docurnenta[ion sub6itted as proof of compllance FOR EACH VIOLAT10N and 1 believe the Information to be true, a=rate, and complete; -photos`Paperwork Statement 3- t am authorized to submit this certification on behalf of the Respondent. 4, 1 am ware that there are signiricant penalties for subrnWing false information, including the possibility of a rine andfc imprisonment for known violations. (HSC 2599'1) Name: Title: rl+nl.+ra�ror�ro+ Signature: a�� bate.