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■ <br /> ■% <br /> ■�' {>INT sAA <br /> Environmental Health Department <br /> g < <br /> PU <br /> RETURN TO COMPLIANCE CERTIFICATION ' <br /> ,,1 S •S L✓I r <br /> Any MINOR violations noted in the"Notice to Comply"In the attached Inspection Report must be corrected within 30 dayE of <br /> receipt of this inspection. This certification fb!m 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 cor ctlons to other violations noted in thel attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> vlolations, are to be submitted using this certificatlon and returned to EHD within 30 deys unless otherwise specified in the -. <br /> Inspection Report, HSC 25185(c)(3) I <br /> Note: All EHD staff time associted with failing to comply by the above noted dates will be <br /> urly <br /> billed at the current horte. <br /> I <br /> For this certification to be co plete, the operator of the site must include: <br /> A statement documenting what co ctive actions were taken or will betaken for each violation <br /> Copies of sample results/manifestshtainmg records/other appropriate paperwork; and/or photos verifying corrections <br /> Operatoft certification August 24, 202` <br /> Inspection Date: Au <br /> 9 h Inspected By: SHEWIT WOLDEARE AY <br /> ^facillty Address: 7700 MORELA�ID ST, STOCKTON CERS ID: 10181359 <br /> rcartify nder penalty of law that have corrected the violations specified in the Ins ection Re ort fro _P p m the above mentioned inspection date. <br /> . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be tre, accurate,and complete,- <br /> Photos <br /> omplete;Photos Pape►work 5taternent <br /> 3. 1 am authorized to submit this certifiLation 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 and/or <br /> imprisonment for known violations. HSC 25191) <br /> P. <br /> Name: �fl'"' 1 GK tE: Title: �+► <br /> I <br /> Signature: Date: <br /> i <br /> Received Time Sep, 14, 2021 6: 2/AM No, 6905 <br />