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z . <br /> Environmental Health Department <br /> SAN JOAQUIN <br /> .r <br /> C.E I,:6; ----•COU+'V l y <br /> Greatness grows ht,c. <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 thts form vnthin 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br /> All corrWions to other voolatiionsnoted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 3Q days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with tailing 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 resuhslmanifestMraining recordslolher appropriate paperwork,andlor photos verifying corrections <br /> Operator's certification <br /> Inspection Date: March 21, 2022 Inspected By: KRISTINA SAETERN <br /> Facility Address: 8606 THORNTON RD, STOCKTON CERS ID: 10180975 <br /> 1 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. 1 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 f Paperwork ✓ Statement <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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: Title: Q 0 ^� <br /> Signature: _Date: <br />