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SA JOA UI Environmental Health Department COUNTY- RETURN u Tf ETU N T COMPLIANCE EF TIFI ATI N Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Deport must be corrected within 30 days of receipt of this inspection, This certification form must be submitted to the Environmental Health Department (EHD) address at the bottom of this form within 30 days of receipt of the Inspection Peport, HSC 25404,1,2(c)(1) All corrections to other violations noted in the attached Inspection Report(IR) or Continuation corm, or disputes to any violations, are to be submitted using this certification and returned to EHD withinwithin 30 daystlays unless otherwise specified in the Inspection Repod. HSO 25185(0)(3) Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. Forth is certification to be complete, the operator of the site must include: A skaternenL documenting what corrective actions were taken or will be taken for each violation Copies of sample res ultsJmanifestsAraining recordslother appropriate paperwork, andlor photos verifying corrections Operator's certification Inspection Date: September 01, 2020 Inspected By: ROBERT LOPEZ Facility Address: 4910 Claremont Ave, Stockton GERS ID: 10145689 I certify under penalty of law that: 1, 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documenlation submitted as proof of compliance FOR EACH VIOLATION and 1 believe the information to be true, accurate, and complete. Photos. Paperwork1k 3tatement 3. lam authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are sonificant penalties for subrniLting false information, including tha passibility of a Fina andh imprisonment for known violations. (HSC 25181) Name: Ammid 00pdmSMmmDwvW Cof4ftN* Title: i Signature: Date, '. I I i