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Environmental Health Department <br /> SANJOAQUIN <br /> COUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> A(cY-MJVQR Wolafions Mled h L40"NOkroe bD Corrlply.iq the atWci ed tnspi�ctton Oep rt mu} kbe cone od wlthin 30.dayss of <br /> reoeipt of his fas cilcrr. This c0r1lfic;uion form musk be submWed to lire Environrrlar W Hsalth Depaftent(FND}address at <br /> the boo rrr of I!s form ilhin V days of rowipt oi;fl,a lhspecwn Reiport, HSD 25404A-2(c)(1} <br /> All Qrr�c#Lorie fo her Jotati res mated irk Uric filtachod 1 nspectlW Repoli(A)or Gorrtinuatfon Form.or dispcites to smy <br /> violations, are W foe sufbmitted mtU this cerlftallon and mtUmed to EHE) wi h'n dgs unl%a otherwise opo~�n the <br /> Inspection Report HSC 251$5(n)(3) <br /> Note., All EB0 staff time assoclated vd h fa illog to comply by the ak�oue noted dates will he billed <br /> at Nle current Molsr1y tato. <br /> For this certification to be compfete, the operator affhe si(afrimti7ckr : <br /> R statement docwnenW wW cwreckive acli B were taken or will be taken for wadi Aofa&r a <br /> Copies of sanlpf9 reoordWother appropr[;M Vaperwork, andlrxr piiotos ved6&T correc1k <br /> oper�LWs aerilficaVol <br /> Inspeetlon Date: Seotembor09,.20 0 Inspected By. NICHOLAS LOEHRER <br /> Facility Address: 27052 HM' IM Ft ALON GUR^e if)- '(0143463 <br /> a <br /> I Certify under ponWky of lam that; <br /> I. i Dove coffected the vlolations spedfied fn the tris wo on RWad korn:he above-MwlflonerV inspection¢ate. <br /> f .2. )hjwca personally examined the failcw ng doc.umenta fort subfnitted as pmoS of compliance FOR I-ACH VlOiATION <br /> + �ncj I believe the informskian to be true, amurate,and comgWe, <br /> i <br /> - - - -Photos,__,__,__,Paparmfk�S�atarrrer�l <br /> 3. !&M avft. r3zed to 8ubrnik this aartirrcatlon ori Behalf of the Respanderd. <br /> f 4. !am aWare that ft5fe are significant pl nMllir*s for submilOng fare irrl rrcat'lon, in-, ¢ing the possibllity of a fit)e <br /> Nr rl km$nk fsxr known vioiskians. (H <br /> 3261911 <br /> r <br /> .I <br /> Name- -Title. <br /> i <br /> � r <br /> Signature, - Date. <br /> t <br /> f <br /> s <br /> ti <br /> i <br /> 3 <br />