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SAN WOUIN <br /> Environmental Health Department <br /> c0U -11: <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Arty M[NO R Violations noted in the `Notice to Cornpty" in the aYlached Inspeclion Report must be Corroded within 30 da s of <br /> receipt of this inspection, This certification form must be submitted to the EnvllonmentaI Health Department(EHD)address at <br /> the boltom of this form within 30 days of receipt of lhs Inspection Report. HSC 2F;404 1.2(c)(1) <br /> All carreciioAs to other viol 0oAs Acted A itte attached IAspeclloA Report(IR)or CcVtA.latioA Form, ur drsputes to eAy <br /> violatloAs, we to be Subrrlilted usiAg this certifcatioA.aPd raturfed to EH0 with[A 34 days uAess otherwise specified iA the <br /> IAspsclloAReport_ HSC251 5(c)(3) <br /> Note: All EH staff time associated with failing to coal ply by the above noted daises will be <br /> tilled at tho current hourly rate. <br /> For this certification to be ccmplete, lyre operator of the site must i,aclude: <br /> A statemeAt dacurneAtiAg what corrective actiaAa were takeAor will be takeA for each viatalioA <br /> Copies of sample resu lishniBA45 stsitra;AWiq recordsfother 0ppropr1ato paperwork,aAftr photos verifyN correctioPs <br /> Operator's certifcatioA <br /> Inspection Date: February 18, 2025 Inspected By: LYNSEY SAMMONS <br /> Facility Addross: 3437 S AIRPORT WAY. STOCKTON CERS ID: 10153883 <br /> I cerlify trAder peAatty of taw thal. <br /> 1. 1 have corrected the viola tioAs specified iA kite IAspectiDA Report from the abrnre-nleAt oMd iAsperficAdate <br /> 2. 1 have parsoAally exam0ed the followft docurneAtatioA ski bmitted as p+baf of wmpli25cr3 FOR EACH VlG APON <br /> aM I believe the iAformaljoA to be true, accurate, aAd complete. <br /> ` Phpt4s _Paperwork StWenlek <br /> 3. 1.am aulho rind to submil this CArlificalioA aAbehalf of the Respoklek <br /> 4. I am aware that there tare slgAiftcaAl peAalties for subrniWAq false WormatioA,iAcludiAg the passibility of a Me aAdlor <br /> irraprisWlmeAtforkfuwAw4lat,oAs. (HSC25191) <br /> Name' ri �,,,, ,+►� '1"rkle: r AI!.r : <br /> Signature ! " ��— Date: <br />