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Environmental Health Department <br /> SANJOAQUIN <br /> C O a NT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN vloli�tions noted in the"Nodre to Comply'in fhe atbRiched Inspection Report rnuM be r cked in 30 dffs of <br /> aJN cf this b-ispacOon. This certifcatlon form must be submitted to the Environmental Health Department(EH D)address at <br /> tha bottom of this form within 30 days of reoeipt of tate Inspection Report, HSC 25404-1.2(c)(1) <br /> Ail cogeWons KSther+Aolat s noted in ChG attac#ted Inspeclion Report(IR)or Contlnuativn Form,or dlspute�to any <br /> violations, are to be submitted uslnp this rertificalion and returned to EHD within 3Qdays unless otherwise specified in[he <br /> InspecUan Report. HSC 25185(0)(3) <br /> Note: All EHD 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 carnplete, tha operator of the site must.Includa; <br /> A statement documenting what corrective acUons ware taken i r will be taken for each violation <br /> Copoee of sample resultslmanlFestsl#ralning recordslother appropriate paperwork, andfor pho(os verifying corcoei as <br /> Operator's certikation <br /> Inspection Date: September 09, 2020 (rtspected By NICHOLAS LOEHROR <br /> Facility Address., 12423 S Manthey Rd, Lathrop CERS ID; 10144027 <br /> I c ortify under penalty of law that: <br /> 1, 1 have oomected the vivlaaons specified in the lnspectlon Report from the above-rlle0onell inspeown date. <br /> 2- I have personally examined the fallowing documentation submitted as proof of compllance FOR EACH VIOLATION <br /> and I be[leve the Informalton to be true. aoCurata, arc]complete; <br /> —Photos—Paperwork Statement <br /> 1 1 am authorized to submit this certifcat on on behalf of the Respondent. <br /> 4. �am atio+am�hW there are slofi,aW periAles for submiWng false information, including the possibility of a fine <br /> andlorimprisorrme rknownviolations- HSC25191) <br /> Name: — — — Tile: <br /> Signature: Date: 1-7 /-Z:o <br />