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Jan. 10. 2020 7: 17PM No, 0750 P. 4 <br /> Page 1 <br /> F,nvironmental Health <br /> Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Repon must be cofreeted within 30 days of <br /> receipt of this inspection.This certification form must be submitted to the)Environmental Health Department(E14D)address at <br /> the bottom 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 in the attached Inspection Report(IR)or Continuation Form,or,disputes to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report.HSC 25185(c)(3) <br /> Dote: All EIID 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 re•9ults/manifests/training records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: December 06,2019 Inspected By: NICHOLAS <br /> LOEHRER <br /> Facility Address: 18961 S LAMMERS RD,TRACY CERS ID: 101$2737 <br /> 1 certify under penalty of law that: <br /> 1.I 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 FAC:II VIOLATION <br /> and l believe the information to be tate,accurate,and complete: <br />