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S A N J U A Q U I N Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR Violations noted to the "Notice to Comply"in the attached Inspection Report must be corrected mthrn 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 Reporl. HSC 25404.1.2(c)(1) <br /> Ail corrections to other violations noted in the attached Inspection Report(IR)or Continuatlon Form, or disputes to any <br /> violations,are to be submitted using this Certification and returned to END 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 <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/manifestsAraining recordslother appropriate paperwork, aridlor photos verifying corrections <br /> Operator's certification <br /> Inspection Date: March 04, 2020 Inspected By: JASON GAITAN <br /> Facility Address: 2800 AUTO PLAZA WAY STE 110, Tracy CERS ID: 10644238 <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 fatlowing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and 1 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_ 1 am aware that there are signifrcant penalties for submitting false information,including the possibility of a fine and/or <br /> imprisonment for known violations. (HSG 25191) <br /> Name: �'� 5 /4{ r , Title: Lu f <br /> Signature: Date: `2-`l-2 0-2-z) <br />