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1 <br /> =a Environmental Health Department <br /> _ . . . ' C) LfNTY <br /> ( 1t <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 (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 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 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: January 13 , 2020 Inspected By : PAUL NSO <br /> i <br /> Facility Address : 1001 E YOSEMITE AVE, MANTECA CERS We 10180593 <br /> 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 . 1 have personally examined the following docymentation 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 /> 44 l 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: AWA SN 511V&�V Title: PxCsi o 9AYT ' <br /> Signature: hDate: 2 • f 1 - zozc, <br /> FEB 12 2020 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br />