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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows hers' <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 Flealth 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 Directions to other violations noted in the attached Inspection Report(I R)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing 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 /> Copies of sample resultslmanfestsltraming records/other appropriate paperworA statement documenting what corrective actions were taken or will be taken for each violation <br /> k,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: March 12, 2024 <br /> Inspected By: KRISTINA SAETERN <br /> Facility Address: 1789 W CHARTER WAY, STOCKTON <br /> CERS ID: 10182247 <br /> I certify under penalty of law tl�af <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 Vl PaperworkS- <br /> 3 I am authorized to submit this certification on behalf of the Respondent Statement <br /> 4 1 am aware that there are significant penalties for submitting false information,including the Possibili of <br /> and/or imprisonment for known violations (HSC 25191) <br /> lY a fine <br /> Name: h <br /> Title: <br /> Signature: <br />