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rj rtment <br /> Ir N <br /> Health Depa , <br /> ?A EnTev, ironmental <br /> IVO <br /> �pj:OF 0: . . . . . . . . . . <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 certification form 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 corrections to other violations noted in the attached Inspection Report ( IR ) or Continuation Form , or disputes to any <br /> ion and returned to EHD within 30 dans unless otherwise specifi <br /> violations , are to be submitted using this certificated in the <br /> Inspection Report . HSC 25185 ( c ) ( 3 ) <br /> Notes, All EHD staff time associated with failing to comply by the above noted dates will be billed <br /> at the current hourly rate . <br /> rtification to be complete , the operator of the site must includeFor this ce <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> aining records / other appropriate paperwork , and / or photos verifying corrections <br /> Copies of sample results / manifests /tr <br /> Operator ' s certification <br /> May 25 , <br /> 2021 Inspected By : VICKY VANGwwwLEE <br /> Inspection Dates. <br /> Facility Address : 2494 E FREMONT ST , STOCKTON CERS IDE. 10181493 <br /> I certify under penalty of law that : <br /> 1 . I have corrected the violations specified in the Inspection Report from the above - mentioned inspection date . <br /> 2 . I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate , and complete : <br /> Photos Paperwork X 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 . ( HSS 25191 ) <br /> Names. <br /> Gurjinder Sohal Title : Owner <br /> ff <br /> Signature : � _ - � — D ate : 06 / 24 / 2021 <br />