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, I Envkonmenta# Health Department <br /> COUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any M rj0F%oWaUons npted in trre Ftatotce io Gt�in the attached Inspection Report muat be of <br /> receipt of els insNcfion, Th%oi�r Waa Ibm rrrrrst be suttmitted to the Envlranmentat Health Department(Ekal address at <br /> Lhe botionm of this forrn voMin 30 days 4f receipt of the Wpecjion Report. NSG 2.5404.1,2(c)(1) <br /> M rrv_rrectivns to other viol s noted in tE a a[taclied ffmpecti;on Report()ff}or Continuation Votm, or disputes to any <br /> violal)ons, are tD be submttteQ using this cettlficafion and teWrned bo t 11D gwilhirr 3D dZY Mtess otherwise spedkd in the <br /> FrrsperWw)Report. KSG 2$4I35(c}(�} <br /> Note, Ali ENCI sta ft Un're asaocia#ed with falling to comply by the above natod mates #off be bWed <br /> ,at thia current hourly rate. <br /> I~artrisaeftifroat'rortto be wmpletef the opE�ratorofthe siternuminctuft; <br /> A atatei-wnt documenting wbal con-ec(W ac uns vmra +ran or will he Laken for vi❑tatlorL <br /> Copies of sampl resuit m niFeses ireirring records r appy Tale poperwo*,andfor photos vcsrifyjng corrections <br /> ' Ope�tor's cer{ifi,caffon <br /> trtspe #+on !]ate; August 20, 2029 lnspected By. N 10,HOL LOEHRFR <br /> t FacifrtyMdvesa: 12070 W LAMMCRS FAD, TRACY cERs p-, 1014b529 <br /> I aerWy under perWly of jv Lhat, <br /> 1, (Have cvmedred ft a t+ d;specified in the Inspecton RE)port from lbe abuv�mell icmeo�riWez r n dam, <br /> J, f tim cn *Xarr►ined the(otloW4rg oCurhet}tation submitted as roof of <br /> ! Y P nTip1i3fico F EACH VJC)LATION <br /> end I b0avke the Wormaftn fa be truer accurate, and complete_ <br /> -Photos_Paperwo*AsudNmon( <br /> tis. i am auMoaed to szrbrr+it ttr)s cMjhcalI c n oa biahW(t)f the Respondent. <br /> i <br /> 1 <br /> i 4, i am award Oat these a;a s 9ftant penaWk For submitting fare intorfnation, inc(ucfing(tie pas6 bAty 0&Erre <br /> ar�dforirrl�ptison�r��rrtt�r#cr�cwvrfivo-�atJo+r+s. �NSC2.b13'i� <br /> itName-, <br /> f <br /> I <br /> i <br /> 1 <br /> I ' <br /> y� <br /> I <br /> r <br />