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Environmental Health Department COU N T -RETURN TO COMPLIANCE CERTIFICATION Any MING violations noted in the "Notice to Corn ply' in the attached Inspection Report must be corrected within 30 day of receipt of this im�pecfion. This certification form rnust be submitted to the Environmental Health Department (EHD) address at ; the bottom of thi,form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(-I} All corrections to other violations noted in the attached Inspection Report (IR)or Continuation Form, or disputes to any violations, are to be submitted using this certlfication and returned to EHD within 30 dove unless otherwise specified in the Inspection Report. HSC 25185(c)(3) Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete, the operator of the site must include: A staten)ant documenting what corrective actions were taken or will be taken for each violation Copies of sample res ultsJmanifestsltraining recordslothc r appropriate paperwark, andlor photos verifying corrections Operator's certification Inspection Date: September01, 2020 Inspected By: ROBERT LOPEZ Facility Address: 16141H1 GOTO T, STOCKTON DER ID: 10640173 certify under penalty of law that' i. I hags corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2- 1 have personally examined the following documentetign submitted as proof cf compliance FOR EACH VIOLATION and I believe the inform alion to be true, accurate, and complete: Photos Paperwork /&I5tatement 3, 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility a a fine andk imprisonment for knawn violations. (HSC 25991) Name: A"nrra 0d dmMrrri 0MWTNd C"r*ll ma Title: Signature: Date;