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Jun 02 20 , 03 : 02p p . 2 <br /> Environmental Health Department <br /> sy ��� gg � [ Yb. I <br /> iA k 'k ill <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 da s 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 biiled <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/manifestsftraining reaordslother appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: May 04 , 2020 Inspected By : NINE <br /> PAUL NSO <br /> Facility Address: 18806 N LOWER SACRAMENTO RD , WOOE CERS i'D % 10181237 <br /> 1 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 /> tion submitted as proof of compliance FOR EACH VIOLATION <br /> 2 . I have personally examined the following documenta <br /> and I believe the information to be true, accurate ; and complete: <br /> Photos lPaperwork Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4, lam 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 : <br /> Date. <br /> Signature : <br /> News <br /> JAS 'S ENTERPRISES INC <br /> 98806 N LOWER SACRAMENTO RD <br /> WOODBRIDGE, CA 95258-92841 <br />