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12/09/2018 08:56 5107963470 <br />SHARN1A <br />PAGE 02 <br />Environmental Health Department <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 inspection. This certification form must be submitted to the Environmental Health Department (E -ID) address <br />at the top of this form within 30 clays 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 />Note: All END 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 <br />corrections <br />Operator's certification <br />Inspection Date: November 09. 2018 <br /> <br />Inspected By: NICHOLAS LOEHRER <br /> <br />Facility Address: 1100 S MAIN ST. MANTECA <br /> <br />CERS ID: 10182243 <br /> <br />I 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_ I 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 X Paperwork Statement <br />I am authorized to submit this certification on behalf of the Respondent. <br />I am aware that there are significant penalties for submitting false information, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Name: Kui.DEV 514Aftim Title: 9tDtht <br />Signature: Date: i),419) <br />()fist L <br />2018-u 9: 55AMYNo, 4464a 952051 T 209 468-3420 I F 209 464-0138 1 www.sjcehd.com Rece ved Line EDec.