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SANJOAQU Environmental Health Department <br /> `'f(If ill gro»t here. <br /> RETURN TO COMPLIANCE E CERTIFICATION <br /> Any KAINORviDjalipns notdd in the'Nplice Ip Comply'in the attached In5peclkion RiL;rpon must be oorrfo hin 41 of <br /> mceipt of this mspeel ion. This corKiicalmn form mu St be submitted to t"Environmenial Health DeParlmant(l HO)address al <br /> the Mitam of this km within 34 days of receipt of the Inspection Reporl. HSC 2`r404,1.2(c)(t) <br /> All noled in the initF ehed Inspeclion Report (IR)or Conlinualiorn Farm. or daspules W any <br /> volat,ons-are to be submitted using This mrt,Ficpatoon and relumed Io EHD vAhlr_30 do unless olhmrvrrse SP9CIfiod in 1I <br /> inspeacm Reped H C 251 a 1(001 <br /> Note: All EHD staff time associated with failing io comply by the above noted dates will be <br /> billed at the cu€rent hourly rate. <br /> For this certification to be complete, the operator of the slte must include- <br /> A statement documeniimg whal cormctive actions were laken or will be taken for each vlolalian <br /> Copies pf sarnpik resulWmandesWraining recorizWother appriapriale paperwork. andllor Oozos venfying wrrections. <br /> Op�ratar's certiticabort <br /> Inspection Date- February 02, 2026 Inspected By: M RIA LOPE <br /> Facility Address: 4747 PACIFIC AVE, STOCKTON CERS 10, 10766 03 <br /> I CeFfy under penalty of law thal <br /> 1. I"ve correcled the vKAations specified in the Inspection Riaporl From Ilse a bove•menWYied inspecllon dale. <br /> 2. I have pers*natly exammed the Following documenlalion submitled as proof of compliance FOR EACH VIOLATION <br /> and I belleve li,e mfarrnalion to be true, accuratff.and complete; <br /> Pholos Paperwork. � _s#alement <br /> 3. 1 am euthonzed to subrwl this on behalf of the Respandenl. <br /> 4- I am aware that Owe are significant penalties for submittiatig f Ws&inFormati0n.including the possibility of a Crie and/or <br /> imPftenment for knew;hokalions. (H SC 25191) <br /> Name, �F�, 1 ay -�C� Title., <br /> signati.r Date- <br />