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,, _ SAN��oAn�l� Environmental Health Department <br />COUNTY— <br />L> <br />Grecu:ess gco,a here. <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 cemfication forth must be submitted to the Environmental Health Department (EHD) address at the <br />bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All wrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, <br />are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection <br />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 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 newrds/other appropriate paperwork, and/or photos verifying corrections <br />Operator's certification <br />Inspection Date: August 09, 2021 Inspected By: GARRETT BACKUS <br />Facility Address: 2478 WILCOX RD, STOCKTON CERS ID: 10825390 <br />I certify under penally of law that: <br />1. 1 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 and <br />I believe the information to be true, awurate, and complete: <br />Photos vl�Paperwonk _Z/Stetement <br />3. 1 am authorized to submit this certification 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 />u,mo MI1PFz--9.4yvja / Tina �;A -Jxce wvH4 nA- e� <br />1858 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209464-0138 1 www.sjgov.org/EHD <br />