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Environmental HeaM Department <br /> x' <br /> COUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIROR vfoiaYum rw%d ii-r the"Ntcq tD c4,3ply°in the 8tftcbed in speCki0p report must be gy e M saiiWin-30 dw of <br /> rem pt of this insQ lw, 'This cerci kation form rfrrfst be st&Mlte4 to Che 1Ernr1ronmr3nta1 Heak(h Vepartf-wW(END)adtireis nt <br /> VR bWjam of ibis(orm Vfithln W days ofrecefpt 4f the inspecwro FtepDrt- jlr>C 2W4-1-2(c)(i) <br /> All MrQa(+onra to oft�f3r 2a s.noM ira The attached 4ispestlon RE�pGrt(iR)or GaflOnaon Form, Or OLVutes to aTry <br /> vlolations, are to be submiftad Lm- tg this cvf ft-ec l and r9turrned to F-HDi i Ljnwse a{hermrpso sped4ed in kite <br /> lnspecUun Report. risr-�5195(c)(3) <br /> Note: All rm"Q staff f4m asacclated With failing t0 comply f)y fho agave no fes date$WJJJ be belied <br /> at tho ourrom hourly rate. <br /> For this certification to be complate, m,Qperatarofne ft m tir,cAude. <br /> statemen( txtrrrer+ f what cvrrsdrM3 ac ons were kaKen or wiff be(aken fur eo&.wda�lm <br /> copies of sampfe rerordWothar apbropriaLe paperwork,ahftr phatm rnerdf inn 4�vrract w <br /> aparatces c"�c Q)n <br /> lxrsp1300n bats: August 20, 2020 By: NICHOLAS LOEHRER <br /> Facility Address, 724 E QRANT LIN F RD,TRACY CERS 1p: ID143053 <br /> i cv§r*ruder p malty of law Mat-- <br /> f <br /> hat:r <br /> s 1- i Mve corrudod dia Vwii*xrms vi36fied in the impF!im Report from the abave-mettklwad k)Wsajoo date, <br /> i <br /> 1 Dave personal Y examNed Me WkwMnq docmankation submItted as proof of cornpdarToa r-OR EACH VokATION <br /> i <br /> ino l believe"ill forma(ion to be trw , aouffatf=, ark CDMPIU-15' <br /> Photos_TP0P0frr * ternant <br /> f <br /> 3. i am a+a zorirad to sukrT7 IH$CeFfftaUOD on b31Ia11 of tha f EeSPo)�e6C <br /> 1. 4. 1 am aware ffit(there are s <br /> igrranh penalties for sUbrrl+tong tWs$irriormaWti, indud�nq tyre possibwv of a 13n3 <br /> andlorlmprisonrnenkCorknownviai*aUofis, (2-# 25191) <br /> Me.. <br /> hpat : - - Date: <br /> f <br /> 4 <br /> III <br /> I <br /> 7 <br /> s1 <br /> #III` <br /> I <br />