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Vt 30 18 05:47a <br />so <br />HARNAM CORPORATION <br />209-830-8293 p.1 <br />46 <br />OCT 3 0 2013 <br />TURN TO COMPLIANCE CERTIFICATIONENVIRONMENTAL HEALTH <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected wr T WPES <br />receipt of this inspection_ This certification form must be submitted to the Environmental Health Department (EHD) address <br />at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br />Ali 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 />For this Certification t0 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 <br />corrections <br />Operator's certification <br />Inspection Date: <br />Facility Address: <br />October 17, 2018 <br />2430 JOE POMBO PKWY, TRACY <br />1 certify under penalty of law that: <br />Inspected By <br />ZUNA BARKER <br />CERS ID: 10182265 <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 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 <br />and/or imprisonment known violations. (HSC 25191) f <br />Name: V f k �-M jrt: -r ��,ct �'E;a Title: 14 P. <br />Signature: Date: ld <br />Received Time=Oct , 30, A2018-' 7:4500o. 4335 .952051 T 209468-34201 F 209464-0138 1 www.sjcehd.com <br />