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j <br /> ta: � ;h> ::::: ' : Environmental Health Department <br /> „• .. <br /> +r <br /> OP <br /> 14 1 01 <br /> d . <br /> • i . , . . . . • . • ; ; , <br /> I :f z41 � . # <br /> Ipp 41 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply" in the attaohed Inspection Report must be corrected within 30 daY.s of <br /> receipt of this inspection. This certification form must be submittdd to the Environmental Health Department (EHD) 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 correction to other violation& noted in the attached Inspection Report (1R) or Continuation Form , or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD withindays unless otherwise specified in the <br /> Inspection Report.• HSC 26185 (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/man'rfests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operatoes codification <br /> Inspection Date : February 13 , 2020 Inspected By : CESAR RUVALCABIA <br /> Facility Address: 15600 S HARLAN ISD , LATHROP CERS ID : WITIF 10180541 <br /> I 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 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 /> 4 , 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or <br /> imp ri$onmentfor known violations. (HSC 25191 ) <br /> Name : III <br /> �1 W Title: <br /> five- <br /> Signature : Date : F ' �' <br /> EAli/Irc? n. fV +, t . <br />