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SAN JOAQUIN Environmental Health department <br /> - CSU NTY <br /> 6rvorn (% % -, <br /> RETURN TQ COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must he corrected within 30 days of <br /> receipt of this inspection. This certification farm must be submitted to the Environmental Health Department ( EHD ) address at <br /> the bottom of this firm within 30 days of receipt of the Inspection Report. HSC 25404 , 1 .2(r,)( 1 ) <br /> All corrections to other violations noted in the attached lnspectron Report ( IR ) or Continuation Fvrm, or disputes to any <br /> violations, are to be submitted using this certificahon and returned to EH ❑ within 30 da sunless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note : All EHD staff time associated with farting 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 /> • Capias of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date.-, June 16 , 2026 Inspected By : MARIA LOPEZ <br /> Facility Address : 1251 E BIANCHI RD , STOCKTON CERS ID : 10782457 <br /> ! 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 . ! have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the in#ormation to be true, accurate , and complete: <br /> Photos )�,�Paperwork Statement <br /> 3 . I am authorized to submit #hr5 certification on behalf 4f the Respondent. <br /> 4 . ! 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 25 1 91 ) <br /> Name : OII�h%NMAL.- � S Title , UV%6�' , . <br /> Signature : Date : <br />