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SAN J O A Q U I N Environmental Health Department <br /> C0UN -I Y <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 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 veriyPt�g��j �q ' <br /> correctionsr <br /> Operator's certification � ; �� <br /> Inspection Date : February 12 , 2019 Inspected By : ZUNA BA4 t� <br /> Facility Address : 16500 S HARLAN RD , LATHROP CERS ID : 10181913 �X�Y <br /> I certify under penalty of law that: <br /> 1 . I 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 /> Photos Paperwork Statement <br /> 3 . 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/orr imprisonment for known violations. ( HSC 25191 ) <br /> Name : 1 t c �t E, � � -' !i lid . ( � p� Title : <br /> Signatur Date : <br /> � G1 � [ l Lo `'( � �� � �I ► �f � �^I C,c. a - C ( � � �� e. Ir E�� It <br /> ✓ � , n <br /> J e I! d U&j ( € <l, U ► <br /> ff I1 p, e. C. c, W ( � L� � E 1 ►� GT dl � ' y � �, U1 �, ec c4tlf � 0 C <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468- 3420 F 209 464-0138 1 www.sjcehd . com <br />