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01:04PM 2098335026 <br />SANt;oJOA0 <br />1N <br />r^ <br />7 '3 <br />1 1' <br />%J %.i <br />P&C AUTO PAGE 01/03 <br />MC 1 Ur% Y CO 1-0�� �ai� III 1%4M "' VI NMENTAL "LAL <br />DEPARTMENT <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br />receipt of this 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 correctiops to other violations noted in tha attached inspection Report (IR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EHD w' bin 30 da s unless otherwise specified in the <br />Inspection Report_ HSC 25185(0)(3) <br />Note: All EHD staff time associated with Failing to comply by the above not®d dates will be <br />billed at the current hourly rate. <br />For this cerrifieaiion 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 <br />Facility Addr®ss <br />January 04, 2019 Inspected �y: <br />2520 W BYRON RD, TRACY <br />I certify under penQlty of law that: <br />NICHOLAS LOEHRER <br />ID <br />CERS : 10183289 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2_ I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br />and 1 believe the informotian to be true, accurate, and complete: <br />Photos <br />Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. I am aware that there are signifi <br />cant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations_ (HSC 25181) <br />Name <br />Signature:, <br />�c w <br />C I"�Lle <br />Title: <br />Date: % J z I <br />�,,8 r _ '7r �. ,.7�,.. � ei,,..�, o r'^''�^-nia 95205 17 209 46E3-3420 I F 209 464-01313 � www.sjcehd.com <br />Received Time fan, 22. 2019 10;03AN� No. 4633 <br />