Laserfiche WebLink
.:r Environmental Health Department <br /> i <br /> COUNTY- <br /> RETURN <br /> i ETURN TO COMPLIANCE CERTIFICAVON <br /> Any MINOR vlolaGons noted In tho"Notice to Comply' in the a[fached Inspection Report musk be corMglh d within 30 of <br /> receipt of this inspection- Thls certiflci�tion farm musk be submltled 1*the Environmental Health Department(EH D)addrens at <br /> the bottom of this form within 30 days of racelpt of the Inspection Report. HSG 25404,1_2(c)(1) <br /> All caire •ons N other volallons r<oted in the attached Inspectlon Rep,od(IR)or Oontihuation Form,or dispuEes to arty <br /> violations, are to be submitted using this cerilRoation and returned to EHO withln 30 dps unless otherwise speclfied in the <br /> Inspection Report HSC 251$5(c)(3) <br /> Note, All EM staff time associated with failing to comply by the above noted dates will be billed <br /> at the current hourly rate. <br /> For this certification to be complete, the operakor of the sale must include; <br /> A statement documenting what corrective acllons were taken or will ba taken fear each viaiallon <br /> Copies of sample resultsfmanifeaWl.raining reaordsfoths r appropriate paperwork, andfor photos verifying corrections <br /> Operators certification <br /> inspection Date: August 20, 2020 Inspected By: NICHOLAS LOEHRER <br /> Facility Address: 27150 Hansen Rd, Tracy CERS «: 10481689 <br /> I certify under penally of law that= <br /> I- I have,oorreoted the Yialations specified in the Inspection Report from the above-mentioned irtspection date. <br /> 2. 1 have personally examined the following documentation wbmitled as proof of comptlance FOR EACH VIOLATION <br /> and I believe the information to be true, aocuraio,and complete: <br /> Photos,_Paperwork �Staterrient <br /> 3. I am authorized to submit this cer0ficabon on behalf of tiro Respondent. <br /> 4, I am aware (hat there are signlHcant penalges for submitting false inforrnatian, fncfudfng(he possibility of a fine <br /> andfor imprisonment for known Volabom. (HSC 25'19'1) <br /> Name: Title. <br /> Signature. bwa,, /16 <br />