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Jun 0819,11:42a p,2 <br /> i <br /> R i^ <br /> Environ ental Health e�aar� ent <br /> JAOUI <br /> 47 <br /> .. . . '' <br /> RETURNTO 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; <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC;25404.1.2(c)(1) <br /> All cordons 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 /> Notes 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/manifests/training recordsiother appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: April 09. 2018 inspect y: BETTY HQ <br /> Facility Address: 34243 S CHRISMAN RD, TRACY <br /> CERS ID: 10181085 <br /> 1 <br /> I ce ' under penalty of law at: <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 documentation submittee as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true,accurate, and complete: <br /> Photos Paperwork --s/tatement <br /> 3. 1 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 and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name: gA t4_rJ T St.N jA1 jr4>N.A.u- c4 Title;_ 67 W <br /> Signature. '� Date: q-7-- <br /> E <br /> I <br />