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SAN J OA O U I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations nated 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 25404.12(c)(1) <br /> Al corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> 'Inspection Report HSC 25185(c)(3) <br /> Note: AI! EHD staff time associated with failing 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 /> Copies of sample results/manifestsltraining records/other appropriate paperwork,andfor photos verifying corrections <br /> Operator's certification <br /> Inspection Date: July 23, 202€7 Inspected By: GARRETT BACKUS <br /> Facility Address: 1810 W FREMONT ST, STOCKTON CERS ID: 10187893 <br /> 1 certify under penalty of law that: <br /> 1_ 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2_ 1 have personally examined the following do�caumentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, aocu te, and cote: <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 information,including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: �� �` �. ;�t��r' Title_- <br /> Signature: Date_ z7& <br />