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07 / 31 / 2020 15 : 02 5107963470 SHARtr*IA PAGE 02 <br /> a400 <br /> 0 <br /> 4 1 Env "ronmental Health Department <br /> :.: <br /> i, r . . . � . <br /> '..i' :SI Y,S q <br /> . • .. <br /> ate: • :' :8 ; ,;e7: �lW nab.., . . r : ,�a_ q , ' 0 i ,.. . ..11 '4 .. 14 <br /> lS1;i'S Y � y <br /> iiarlli+l {t;tfez . I Pt01It„01f$ 1` sisliEx :' k! !i,,9 . e, yiu : h"u?, <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINQg 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 at <br /> the bottom of this form within 30 days of receipt of the Inspection Report . HSC 25404 . 1 . 2(c)( 1 ) <br /> All orrecions to other violations noted in the attachedDinspection 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 EHD staff time associated with failing to comply by the above noted dates will be billed <br /> 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 : July 02 , 2020 Inspected By : PAUL NSO <br /> Facility Address : 1711 E Yosemite Ave , Manteca CERS ID : 10422475 <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 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 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 ; U1 p ESQ 5N�\1\ A Title:_ MI�MbE INS tLA-4EL <br /> Signature: Date: <br /> AUG 0 3 2020 <br /> ENVIRONMENTAL HEALTH <br /> PERNIIT / SERVIGES <br /> Received Time Jul , 31 . 2020 5 $ 03PNi No , 6134 <br />