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SAN J U AQ U I U Environmental Health Department <br /> t_01iiiV l 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 oertifiration form must be submitted to the Envifonmental Health Department(EHD)address at <br /> the bottom 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 he submitted using ttds certlfication and fetumed to E H D within 30 days unless otherwise sped fied In the <br /> Inspection Report. HSC 25185(e)(3) <br /> Note: All EHD staff time associated with tailing 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 /> Capies of sample resultslmanifests/training reeordsMher appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: July 10,2019 Inspected By: ZLINA BARKER <br /> Facility Address: 983 Moffat Blvd Manteca CERS IDi 10132636 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above mentloned inspection date. <br /> 2. f have personally examined tha following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,and complete: <br /> s <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 infwmatioa,including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: W l% mpfu Title:(l11M PW RA NkL WM 11111 Sj& TVP, <br /> Signature: QVf1La& Bate: �sII <br /> 1868 E.Hazelton Avenue I Stockton,California 952051 T 209 468-34201 F 2D9 464-0138 1 w wf.sjcehd.corn <br />