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A N d D A N I Environmental Health Department RETURN To COMPLIANCE CERTIFICATION q-,y MINOR Aolaliors no[ad In IYW"Notcs to a'n'.ply'in the etfarthsd Ins,ectim krpprl muss be oarrKwd tvie3f receipt of Ns inspect on. T7is oar'Iffa!inr fora must be s:,hmiHed to'hi.tnvimnmerta1 HeAlill poaartment{ENu}@Odruss et I'*^bottom of tr.A ro•rr wits in 30 iAytE of,aD--ipt Of-.11f,I--speciian Repgri. HSC AllM�e o Ietians nn1eJ in tae atteclre[i lnspec�ion R,-.po�:IR'I or CCXNAi,otion Farm.or dhputcs to any violations,Ark-t6 be subm tted using this cert tlwatkan and returno to EH d within 30 davg u,?less Ot'SP.rwiaa speofied in rhe Ins,e:;ion Rapar. RSf:251135(c)(3) Nolo: All r=HD staff time assaclated with falling to comply by the above nota%d dotes will be billed at fhe tDrrent hourly rate. For this certification to be mrrlplete, thL-rpperataroft-%esiro must n%,de: A.S12Soment dalaimeriting what wirput've echons%verc taken or juill he taker-or each Aularhon Copies of aaroaly moult. rnai iifortal rsini-g rezrdsiother sp,)opriata pepeNvoi k.and or pho:oe%&&r Eying corrc-,-.-.mi iL, Operxirr s oerbficethr Inspection tate: Ja71,i8iry 04,2022 Irtspactad By: �3TACY RIVE RA FwAity Address: 5777 S FRENCH CAMP Ra,STOCKTON CERS ID. 10182157 I f.uRifv undL-pg-oIty of Iavi rnat: I have rrkwdtad rhe violatiuns apecifled In the Inepechwi Report from-he abase-nertior.�,.y inspect on date. 2. 1 have i;orsonslly exaft,ined the folliming dcclirrterq;);ion submitted as proa`of cor•,NliNnce FOR EACH VOOL TION and J believe 11)&irfcrmstien ro be true,awirLale,and ooir.ol�ft; Phploa papGnvork Slalemem 3- 1 arry eutherize d b a:;bmlt this Cortificstion an bthaff of the Re pondart 4. 1 en ewale treat there ars aign,ficent p�lokies for suDm lting fsbe InWrrlation rodkAn.qIt!o poestbiIit3r nr*!Inu 3rld or irrpriseinlrruni fa•knox.n uadatons._-S ./ . /P Norrie; .Ttle: Slgnature:� _Date;