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S.t'k JOAQLL% COl.MT1' <br />ExylRONWINTAL HCALTii DEPnRTMl,%T <br />6W E, Mw St. S404kni. CA 952W-1029 <br />rte: t,lwtaea-laZt;F�: tzoagara•aaa} n°.w uawtaaoeurvtehd <br />RETURN TO COMPLIANCE CERTIFICATION <br />Anv MINOR violatiatis noted in the "Notim to Comply` in the attached InKg0ion Report must be <br />corrected within 3D 4W of rote* of tlds inspee-tion. This certifi ono &arm must be subartitted to the <br />Envimnfnental Health Depnttment (EHD) address of lire top of this form within 35 days of roocipi of the <br />lmpecleun Report. <br />All corrections to other violations noted in the otinched Inspection Rvwrl or Cootinuotion Form, or <br />disputes to any vioLuions, are to be submitted "q ehu omirication and returned to EHD within 34 Java <br />unless otherwise specified in the lncpeetion Repon. <br />Nate: A0 EHD staff time wsodated with. [ailing to comply by the above noted dater win tw billed M <br />the current hoarb. rate (5122), <br />For this certification to be complete the operator of the site must mctude: <br />a A statcmmi documenting what oarfactivc actions were lakes or will be taken for each %iolebm <br />• ['opies of xanrplr resSul�'tnanifest3Yraitsing records'nthsr apprnQriate paperunrk, arirL'or photos <br />verifyingcoffe tions <br />• t7paanir x catifscati+Kt <br />Inspection Date; Av G... sT t3 i U Inspected BY: <br />TCF-€ v—t� 7.E t�S <br />Facility Addrem:h,, w:n. Cv!.rt^tE1�.4ID#: r. �r�C' <br />I Lemfy Unitj pc" v of Ltw thm: <br />1. 1 have corxaod the viotatwnx spimifie i in the Inspaclion Report from 1hs abov+amenlioned <br />rnspecimn dale. <br />2. 1 have personally examined the following documentation submilled as prw(of aximphisrom FOR <br />EACH V TOL ATION and I believe the information to be true. occurota. and complete; <br />.Photos r_Pgmwrrk '' Staternern <br />3. [ am authorized 1D submit this certification ca behalf Df the Respmdent. <br />4. [rim nwnrc that itxrc arc sig»ificaei penallies far submitting faire infmmotion, including the <br />pmimbilrty of a Pint *mWor wptuumment for known violations. (HSC 25190 <br />Na=- ►^r�Pl?,1L 3>Title: C.r s.. fr)nb- .Cp � <br />Date: <br />EHD :2-42-W Re% I W17 <br />