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Environmental Health DepartmentRETURN TO COMPLIANCE CERTIFICATIONAny MINORviolations noted in the “Notice to Comply” in the attached Inspection Report must becorrected within30daysofreceipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address atthe bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1)All corrections to other violationsnoted in the attached Inspection Report (IR) or Continuation Form, or disputes to anyviolations, are to be submitted using this certification and returned to EHDwithin30daysunless otherwise specified in theInspection Report. HSC 25185(c)(3)Note: All EHD staff time associated with failing to comply by the above noted dates will be billedat the current hourly rate.For this certification to be complete,the operator of the site must include:· A statement documenting what corrective actions were taken or will be taken for each violation · Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections· Operator’s certificationInspection Date:Facility Address:Inspected By:CERS ID:May 04, 202025651N HWY 99, ACAMPOPAUL NSO10181469I certify under penalty of law that:1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date.2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIONand I believe the information to be true, accurate, and complete:_______Photos _______Paperwork _______Statement3. I am authorized to submit this certification on behalf of the Respondent.4. I am aware that there are significant penalties for submitting false information, including the possibility of a fineand/or imprisonment for known violations. (HSC 25191)Name:_____________________________________Title:________________________________Signature:__________________________________Date: _______________________________