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Environmental Health Department <br /> SANJOAQUIN <br /> C OU N T - <br /> F ETUI N TO COMPLIANCE CERTIFICATION <br /> Any MINQR vitiations rated 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 DapartmenI(EHD) address all. <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404. (c){1} <br /> All corrections to other-+Iolations.noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br /> viols tions, are to be submitted using this certification and raturned to EMD within 30 days uniess otherwise specified in the <br /> Inspection Report. HSC 5185(c)(3) <br /> Note: Al E H D staff time associated with failing to comply by the above noted dates will be <br /> bitted at the current hourly rate. <br /> Far this oe rtifi cation to be compI lite, the operator of the site must include: <br /> A statement documenting what corrective actions were taken or will betaken for each violation <br /> Copies of sample res ullsfmanifestsllraining recordslather appropriate paperwork, andfor photos verlfying corrections <br /> Operator's certification <br /> Inspection Date: September 16, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address: 8407 Ielfey Dr, Stockton CERS ID: 10143457 <br /> certify under penalty of law that: <br /> 1. l have corrected the violations'specifted in the Inspection Deport from the above-mentioned inspection date.. <br /> 2_ I have personally examined the following documentation subrnifted as proof of compliance FOR LAOH 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 penafties for submitting False Information, Including tha possibility of a fine andh <br /> imprisonment for known viotations. (HSC 25191) <br /> Name: Title. <br /> Title: <br /> ignatur Date; A02 �^ <br /> i <br /> i <br /> i <br /> i <br /> i <br /> I <br /> I <br />