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SAN 10 A Q U( N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Aitiy°MINQR,violations,noted=lrt he.,Notice-toy Gomply'%i the.,,attached inspection,Report.must be::corrected.within 30jays,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- rret:tions�toxather,violations—:note�.in;the,attacheduInspectton•,Reportz{Its)dr'Cdntinuation-Forml orAisputes;to any <br /> :riQlatt 0s;ar&trr,bejsubmittedt;�tsingathis.;certification�and=rbttrrneci Fi D viiitkrin 3tJEtlatr unlesswotheruvise pe- ed 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 <br /> billed 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 photos verifying corrections <br /> Operator's certification <br /> Inspection Date: March 14, 2024 Inspected By: HAZA SAEED <br /> Facility Address: 4863 CARPENTER RD, Stockton CERS ID: 10138539 <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. 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 /> X Photos X Paperwork X 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 and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: John Pallen Title:_Environmental, Health, Safety, and <br /> Sustainability Manager <br /> Signature: <br />