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San Joaquin County <br /> Envrtonmental Health Department <br /> 7868 East Hazelton Avenue Stockton , California 95205 - 6232 <br /> Telephone : j2091 468 - 7420 Fax : ( ? 091 468 - 3433 Web : wuv;� s cpv orn ' ehtl <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in [ he " Notice to Comply ' in the attached Inspechpn Repan must be correctetl wRhm 30 tlays pf <br /> ceipt of this inspection Ths certification fano must be submitted to the Envrtonmental Health Department ( EHD ) atltlress <br /> at the tap o ! the (arm wrthm 30 days of receipt of the Inspection Report . HSC 25404 1 2 ( c ) ( 1 ) <br /> All co « eceens to other violations notetl in the atlachetl Inspection Repan { IR ) or Conbnualron Farm . or tlisputes to any <br /> pialions . are to be submitted using this certification and returnetl to EHD within 30 tlays unless otherwise specified m the <br /> Inspection Report HSC 26186 ( c ) ( 3 ) <br /> Note : All EHD staff time associated with failing to comply by the above noted dates will be <br /> billetl at the current hourly rate . <br /> For this certification to be complete , thepperaorpnhesitemustinuade <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 , andlor photos. ven (ying <br /> ecbons <br /> Operator s cenifipation <br /> Inspection Date : May 12 , 2021 Inspected By : Eianna Ronda <br /> Facility Address : 1204 E MAIN ST CERS ID : 1018161 <br /> I ce Nfy under penalty of law that <br /> 1 I have correctetl the violations specifietl In the Inspection Report from the abovetrientioned inspection date <br /> 2 I have personally examined the following tlocumentation submittetl as proof of compLance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate , antl complete. <br /> Photos `b Papenvprk a Statement <br /> 3 I am authorized to submit this certification on behalf of the Respondent . <br /> 4 I am aware that there are signifrant penalties for submiping false information . Inclutling the possibiliy of a gine <br /> and /or imprisonment for known violations . ( HSC 25191 ) <br /> Signature : � 1 � 9 Date : i0 - ti - ZI <br />