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5 <br /> S A J O Q I Environmental Health Department <br /> C 1-JT Y <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQR vialallons 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 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 Raport (Ifs)or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to EHO withinwithin 30 daVsdaVs.unless otherwise specified in the <br /> Inspection Deport- 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 /> Forth Is certificatio Cl 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 resultsfmanifestsltraining recordW Cher appropriate paperwork, andlor photos verifying oorractlons <br /> Operator's certiflcatlon <br /> Inspection Date: September 17, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address, 7965 E FOPPIANO Lel, STOCKTON CERS ID: 10145677 <br /> I certify under penalty of law that; <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned Inspection state, <br /> . 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. lam authorized to submit this certification on behalf of the Despondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the passibility of a fine and)( <br /> imprisonment for known violations. (HO 25191) <br /> Amww Name: °" """' Tile: <br /> Signature: Date: &hL <br /> r <br /> ' i <br />