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x,19 - 07m02 15 : 19 TRACY TRUCK STOP 12098322312 > > P 1 / 6 <br /> � , . . <br /> : . . ,do <br /> Environmental Health Department <br /> nt <br /> .. nn. ;r SAN if 1 41 " PIP � . <br /> �Si"Rr�f??���� rC^?a . Css gg ,qW5. IIC%"f <br /> led <br /> RETURN TO COMPLIANCE CERTIFICATION <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 Inspoction . This certification form must bo submitted to the Environmental Health Dopartment ( EHD) address <br /> at the bottom of thls form within 30 days of receipt of tho inspection Report. MSC 25404 . 1 ,2 (c ) ( '1 ) <br /> All corrections to other violatl ns noted In the attached Inspection Report (IR ) or Continuation Form , or disputos to any <br /> violations, aro to be submitted using this certification and returned to EMD within 30 days unless otherwise specified In the <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 /> 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 /> Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : June 26 , 2019 Inspected By , LYDIA BAKER <br /> Facility Address : 336 E MAIN ST, RIPON CERS ID : 10788886 <br /> A <br /> I certify under penalty of law that: <br /> It I have corrected the violations specified in the Inspection Report from the above-mentloned 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 , 1 am authorized to submit this certification on behalf of the Respondent . <br /> 4. 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine end/or <br /> imprisonment for known violations, (HSC 25191 ) <br /> Name .: \ OQ ,Qv' A. 0, Title : O W rveiw (3 )clexa: o2 <br /> Signature :_ 1 ►�` L Date : 2� moi . <br /> kgmv <br /> J <br /> JUL 9 3 2019 <br /> 1868 E. Hazelton Avenue ( Stockton , California 95205 I T 209 468-3'420 I PN <br /> 20�9� N ' <br /> L <br /> Received Time Jul . 2 . 2019 5 : 46PM No • 5229 <br />