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1 <br /> hquir JH UH � I IV l= nv0V (0) �16if11 (� (i`Gd 'l;<� � =� C �] � `iUll Doe[p) avt( 5v1C=� ff� '� <br /> COuN1Y <br /> 10ir Greatness grows here . <br /> i <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 j <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 <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 records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : June 09 , 2020 Inspected By : SHEWIT WOLDEAREGAY <br /> Facility Address : 1987 W ELEVENTH ST , TRACY CERS ID : 10156819 <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 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 X 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 : <br /> Keith B . Powers Title : Environmental Compliance Manager <br /> Signature: <br /> Lt - - Date : 6/ 10/2020 <br />