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Environmental Health Department <br /> SAN _] OAQUIN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply" In the attached Inspection Report must be cQrrectewith n 30 s of <br /> recoipt of this inspection , This certification form must be cubri to the Environmental Health Departrnent ( PWD) address at <br /> the bottom of this form within 30 days ofreceipt of the Inspection Report, HSC 25404. 1 . 2(c) ( 1 ) <br /> All py,L8 toothers 1a14 t� noted in the attached Inspection Report ( IR ) or Continuation Form , or disputes to any <br /> violations , Are to be submitted using this certlfication and returned to EHD unless othennilse specified in the <br /> within 30 dayg <br /> Inspection Report . HSC 25185(c) (3) <br /> Note : All EHD staff time associated with falling to comply by the above noted dal :es 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 records/other appropriate paperwork, and/or phoWs verifying corrections <br /> Operator's certification <br /> Ma 17 , 2022 Inspected By : JOHN ALANIZ <br /> Inspection Date : Y - <br /> Facility Address : 1612 W HAMMER LN , STOCKTON CERS ID : 10181241 <br /> I certify under penalty 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 <br /> and I believe the information to be true , accurate, and complete : <br /> Photos paperwork Statement <br /> 3 . 1 am authorized to submit this certiflcatlon on behalf of the Respondent. <br /> a . 1 am aware that there are significant penalties for submitting false information , including tNi possibility of a fine <br /> and/or imprisonment for known violations. ( HSC 26191 ) <br /> 1� <br /> Name: Title: <br /> Signatur <br /> Date : <br /> kLGEIVED <br /> .JUN 0 � 2022 <br /> r_ NVIRONMENTAL HEAUH <br /> PFRMIPSERVICES <br /> Received Time Jun , 1 , 2022 11 : 34AM No , 7218 <br />