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SAN Q Q Environmental H�a1� Department <br /> 10 i'D18 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br /> HEALTH 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 254D4.1.2(c)(?) <br /> All corrections to other violations noted in the a tached Inspection Reoort(IR)or Continuation Form,or disputes to a-y <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report, NSC 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 cperator of the site must include: <br /> A statement docurnerting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resuits!manifests!training recordslother appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operators certification <br /> Inspection Date: Sep einber 10, 20'18 Inspected By: LYDIA BAKER <br /> Facility Address: 3500 AUTO PLAZA WAY, TRACY CERS ID: 1018401 <br /> 1 certify under penalty of law that: <br /> 1. 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`he information to be t ue,accurate, and complete: <br /> Photos Paperwo k Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. f am aware that there are significant penalt?es for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name_ 1 =i ,Y';. i i? _ Title: <br /> i <br /> Signature: �: t(,r1 /�,-:- i Date: <br /> r <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 I T 209 468-3421)1 F 209 464-0138 1 A wv.sjcehd corn <br /> �-d egtl:I.1, '96 01.100 <br />