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SAN JOAUUIN Environmental Health department <br /> C Q U N T Y <br /> Gircorness grow $ hor <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the '' Nonce to Comply" in the attached Inspection Report must be corrpc:Ced within 30 days of <br /> receipt of this inspection This certification farm must be submitted to the Environmental Health Department ( P-ID ) aciciress at <br /> the bottom of this forte within 30 days of receipt of the Inspection Report HSC 25404 . 1 2 (c)( 1 ) <br /> All corrections to other violations Hated in the attached Inspection Report ( IR) or Continuation Farm , or di.sputes to any <br /> violations , are to he 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 billed <br /> at the current hourly rate . <br /> For this ceftification to be complete , the operator of the site must include <br /> A statement documenting what corrective actions were taken or will be taken dor 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 : March D8 . 2021 Inspected By : VICKY VANG- LEE <br /> Facility Address : 1789 V11 CHARTER WAY , STOCKTON CERS ID : 10182247" <br /> Fi certifji under penalty of law that' <br /> 1 . 1 nage corrected the violations specified in the Inspection Report from the above-mentioned inspection date <br /> ?_ 1 have personally examined the fallowing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate, arid complete <br /> .� Photos Paperwork statement <br /> 3 I 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 <br /> and/or imprisonment for known violations . (HSC 25191 ) <br /> Name -. ��_ t cru D � � � � h Title , art � t� <br /> Signature -. Date : �� Z I <br />