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SAN�'JOAQUIN Environmental Health Department <br />- - Grenxnos: glows lrrrc. <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOB violations notetl in the'Notica [o Comply" in the attachatl Inspection Report must be co ratted with'n 30 tlays of <br />acaipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) etltlress et the <br />bottom of this form within 30 tlaya of receipt of the Inspection Report- HSC 25404. t2(c)(1) <br />All corrections Fo other v'olato nofatl in the attachatl Inspection Report (IR) or Continuation Fonn, or disputes [o any violations. <br />era [o ba submittetl using this certification antl returned [o EHD within 30 tlays unless otherwise specifietl in the Inspection <br />Report. HSC 25185(c)(3) <br />Nota: All EHD staff time associated with (ailing to comply by the above notetl tlates will ba billed <br />at the current hourly rata_ <br />For th is certification to be complete, the operator of tna site mase lnpivae: <br />A statement tlocumantin9 what corrective actions ware taken or will be taken for each violation <br />Copies of sample results/manifaslsttraining recortla/other appropriate paperwork, antl/or photos variying corrections <br />Operator's certification <br />Inspection Data: August 09, 202'1 Inspected By: GARRETT BACKUS _ <br />Facility Ariarass: 2478 WILCOX RD, STOCKTON GERS ID: '10825390 <br />1 certify under panalfy of law [hat <br />1. I have correctetl the violations specifietl in the Inspection Report from the above-mantionetl Inspection tlata. <br />2. 1 have personally axaminatl the following tlocumenia[ion submittetl as proof of compliance FOR EACH VIOLATION antl <br />1 believe fhe Information [o be true, occur/ate, and complete: <br />PhotosPaperwork �S[a[ement <br />3. I am authorizaO to submit this cartihcation on behalf of the Raspontlent. <br />4. I am aware [hat [here are signiFlcen[ penalties for submitting false informafion, including the possibility of a fine and/or <br />rmprisonman[for known violations. (HSC 25t8t) <br />4:N\'IKUNBIIii\'1',\1, IIP..\1:1'll <br />1868 E. Hazelton Avanua Stockton. Califomfa 95205 1 T 209 468-34201 F 209 464-0136 www-sl9ov.org/EHD <br />