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Environmental Health Department <br /> SAN JOAQUIN <br /> ,Chess gtc1" herE <br /> RETURN <br /> TO �OMPLIAIN�E CERTIFICATION <br /> Inspection Report must be corrected within <br /> address <br /> violations noted in the'bloboe to Comply <br /> in the attached artment <br /> roust be submitted to the Environmental Health eP <br /> Any MIN R cation form Inspection Report. HSC 25404.1.2(c)(1) <br /> receipt of this inspection- This of the disputes to any <br /> within 3D days of receiptor disp <br /> at the top of this form ort(IR)or Continuation Form, specified in the <br /> Inspection Rep ( <br /> ' within 30 days unless otherwise <br /> qll rr c n r other_---Vi0I�t1Ons noted in the attached Insp <br /> violations, are to be sub 25�85(c)(ng 3}this cert fiction and returned to EHD �----- S will be <br /> inspection Report. HS the above noted date <br /> Note: All EHD staff time associated with failing to comply by <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 takers or will ill b be taken for each violation paperwork, and/or photos verifying <br /> appropriate Copies of sample results/manifests/training records/other apI p <br /> corrections <br /> Operator's certification <br /> Inspected By: LYDIA BAKER <br /> Inspection Date: December 04, 2018 — <br /> Facility Address: 3400 AUTO PLAZA WAY, TRACY <br /> CERS ID: X10183431 <br /> /certify under penalty of law that: <br /> 1. /have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 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. I am authorized to submit this certification on behalf of the Respondent. <br /> 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 /> ime: _Title: Vd, �4,wNi? <br /> 7ature: F ��` [date: - q, <br />