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SAN.. <br />Aq N Environmental Health Department <br />CGUI\ITY <br />'7r l:a. (ilArit ripf4 tlf+>fV5 ill?I U, <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR vloiatlons noted In the "Notice to Comply" In the attached inspeotfon Report must be corrected within 30 days of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EMU) address at <br />the bottom of this form within 30 days of recelpt of the Inspection Report, HSC 26404,1.2(0)(1) <br />All corrections to other violations noted In the attached Inspection Report (IR) or Contlnuallon 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 26185(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 />F'or this certification to be complete, theoparatorof lhesilemuslinclude: <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />Copies of sample resullslmanifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />operator's certification <br />Inspection Date; June 30, 2021 inspected By: <br />Facility Address: <br />ELENA MANZO <br />3515 Navy Dr, Stockton CERS ID: 10157A77 <br />1 certify under penalty of law that: <br />1. I have <br />corrected the violations specified In the Inspection Report from ihea�ove-mentioned Inspection date. <br />2. I have personally examined the following documentation <br />submitted as proof of compliance FOR EACH VIOLATION <br />and I believe the Informailon to be tme, accurate, and complete; <br />Photos x Paperwork x Statement <br />3. I am authorized to submit this cedlficalfon on behalf of the Respondent. <br />4. I am aware that there are signifi <br />cant penalties for submitting false lnformalion, Including the possibility of a fine andlor <br />Ir»prlsonment for known vlolatlons. (HSC 26191) <br />Name: i/../.(I Ae(/.& Title: r�e C, IA %/ <br />