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Environmental Health Department <br /> C� k � jaAf1UI <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations 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 <br /> at 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 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 : All 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/manifests/training records/other appropriate paperwork , and /or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : April 25 , 2019 MENEWE Inspected By : ZUNA BARKER <br /> Facility Address : 3940 N TRACY BLVD , TRACY CERS ID : 10182335 <br /> I certify under penalty of law that : <br /> 1 . I have corrected the violations specified in the Inspection Report from the above- mentioned inspection date . <br /> 2 . 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 . 1 am authorized to submit this certification on behalf of the Respondent . <br /> 4 . I am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or <br /> imprisonment for known violations . ( HSC 25191 ) <br /> Name : t vt A,0 T Uq Title : Ot-v n %e r l 'n rc:t to 64L <br /> Signature : "� �_C'\p ( �� Date : 5 t a ( 20 l q . <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468-3420 l F 209464m0138 I www . sjcehd . com <br />