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K~&&� U��� UKK&A <br />� ���������0�U� <br />=~"","��~~""~a~~""° <br />�/. (_0U1\1TY <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />receipt Vfthis inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />All corrections to other violations noted inthe attached Inspection Report (|F)orContinuation Form, ordisputes hoony <br />violations, are h)besubmitted using this certification and returned kzEHD within 30 days unless otherwise specified inthe <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 />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 <br />corrections <br />Operator's certification <br />Inspection Date: July 12, 2018 Inspected By: CESAR RUVALCABA <br />Facility Address: 37350 S BIRD RD, TRACY CERS I nh <br />Ld <br />I certify under penalty of law that: <br />1. | have corrected the violations specified inthe 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 information to be true, accurate, and complete: <br />Photos -Paperwork Statement <br />3. |amauthorized bnsubmit this certification nnbehalf ofthe Respondent. <br />4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: Title: <br />Signature: <br />