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i <br /> I <br /> SJOAOJy/+yyy N I{JI ,yi11 Environmental Health Department <br /> ICoUNIT ' <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MING violations noted in the'Notice to Comply" in the attached Inspection Report must be corrected wifhln 30 dabs of <br /> receipt of this inspection. This ceriirication form must be submitted to the Envirorlrrmenlal Health Department (EHD) address at <br /> the hot tom of this farm 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 Depart(IR) or Continuation Form, or disputes to any <br /> violations, are to he submitted using this certification and returned to EHL)within 30 days unless alherwise spec'rfied in the <br /> Inspection Report, HSC 25185�c)(3) <br /> Note: All E H D staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this oertifi cation to be complete, the operator of the site musk include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of saw pie resultslmanffes.Mraining recordslother appropflate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: September 18, 2020 Inspected By: ROBERT LOPE <br /> Facility Address: 3975 N Wilson Say, Stockton DERS ID: 10145777 <br /> I certify under penalty of law that; <br /> t. 1 have corrected the violations specified In the Inspection Report from the above-mentioned inspection date. <br /> 2- 1 have personally examined the following docLpmentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and oomplete: <br /> Photos Paperwork Xstatoment <br /> 3, I am authorized to submit this certification on behalf of the Respondent, ; <br /> 4. I am aware that there ane significant penalties for submitting false information, Including tha passibility of a fine andA <br /> imprisonment for known violations- (HSC 251 Qi) <br /> A"pwName: "' * Title: <br /> Signature: bate: ' <br /> i <br /> i <br /> I <br /> i <br /> i <br />