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` SAGOAQUIN Environmental Health Department <br /> :^ l ' . -- COUNITY -- <br /> '' srecs, .: <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 25404A ,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 <br /> billed at the current hourly rate. <br /> I <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 recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: January 24, 2020 Inspected By: SHEWIT WOLDEAREGAY <br /> Facility Address : 1975 W LOWELL AVE, TRACY CERS ID : 10181579 <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 fallowing 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. 1 am aware that there are significant penalties for submitting false Information, Including the possibility of a fine and/or <br /> Imprisonment for known violations. (HSC 25191 ) <br /> Name: Casey J . Goodall Title: Associate Superintendent for Business <br /> Services <br /> signature: Date: February 5 , 2020 <br />