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/�`yy /injj `,`■{yI Environmental Health Department <br /> SNJOQUICOUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR Volations noted in the"Notice to Comply' in the attached Inspection Report roust be corrected within 38 days of <br /> receipt of this Inspectlon, This cediFicetion form must be submitLed to the Environmental Health Department (EHa) address at <br /> the bottom of this form wlthln 30 Mays of receipt of the Inspection Report_ HSC 25404-1-2(c)(1) <br /> All carrections to other violations noted in the attached Inspection Report (IFS) or Continuation Form, or disputes to any <br /> violations, are to ha submitted using this certification and returned to EH within 30 daV unless otherwise specified in the <br /> Inspection Reporf. HSC 25185(c)(3) <br /> Note: All E H D staff time associated with failing to comply by the above noted slates wiII tae <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 w1I I be taken for each violation <br /> Copies of sam pie res ultslmanifestshraining record sfother appropriate paperwork, and/or photos verifying corrections <br /> Oparator s.certification <br /> Inspection Data: September 16, 2020 Inspected By: ROBERT LOPE <br /> Fac i I ity Ad d ress: 7602 Murray Dr, Stockton CERS ID: 10145453 <br /> certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentiorxed inspection date_ <br /> 2. 1 have personally examined Lhe following documentation sub mltta as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to he true, accurate, and complete; <br /> Photos _Paperwork Statement <br /> 3_ 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4_ t am aware that there are significant penalties for submitting false information, including the possibility of a fine and/( <br /> imprisonment for known violatlons. (HSC 25981) <br /> Name: 't"""��nwiw0WWftnW Title: <br /> I <br /> Signature: Date: <br /> I <br />