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^,'";,,:-=+; <br />$ Atr{,#Se#f"*f ffi <br />ii,,, :" <br />*#{:*"-r*\irY* <br />lr,. .,.,. *rf#*fitr$s 6r.:rtl fo{*f. <br />Hnvironmcntal Health Department <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 davs 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 (lR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EHD within,30 davs unless otheruvise specified in the <br />Inspection Report. HSC 25185(c)(3) <br />Note: Att EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this certiflcation to be complete, tn" operator or the site must inctude: <br />. A statement documenting what corrective actions were taken or will be taken for each violation. Copies of sample results/manifests/training records/other appropriate papenrvork, andlor photos verifying corrections <br />' Operator'scertification <br />Inspection Date: November 06,2023 Inspected By: ALBERTO FERNANDEZ <br />Facility Address: 437 N WILSON WAY, STOCKTON GERS lD: 10180899 <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 'X P"perwork <br />-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. (HSC 25191)