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DEC/ 27/ 2018/ THU 09 : 22 AM FAX No , P1001 / 001 <br /> , � A {� i Environmental Wealth Department <br /> r HQU <br /> `IX <br /> Nis h � sk Greenness grows hero , <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 (END) address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1 .2(c) (1 ) <br /> All corMqXL,Q,ns, +ether 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 Deport. HSC 25185(c) (3) <br /> Note: All EMD 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 <br /> corrections <br /> Operator' s certification <br /> Inspection Date . November 28 , 2018 Inspected By : LYDIA BAKER <br /> Facility Address : 30708 S MACARTHUR DR , TRACY CERS ID . 10182117 <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 /> 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 imp P•sonment for known violations. (HSC 25'191 ) / (� CoJ <br /> Name : LTitle* <br /> Dta/b�- 1 Title: �"f ` Ct� � LCM <br /> Signature: -, "" � Date: <br /> 1868 E. Hazelton Avenue J Stockton , California 952051 T 209 468-$420 J F 209 4640138 1 www •sjcehd . com <br />