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i <br /> SANJOAQUIN Environmental Health Department <br /> C QrJ N TY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the'Notice to GomplV' in the attached Inspection Report must be corrected within 30 days of ' <br /> receipt of this inspection, This certification form must be submitted to the Errvironnnerital Health Department (EHD) address at <br /> the bottom of this form W1thIn 30 days of receipt of the Inspection Report. HSC 25404.12(c) } <br /> All corrections to other violations noted in the attached Inspection Reporf (IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification and relumed to EHD wiLhIn 34 days unless otherwise specified in the <br /> Inspection Report, HSC 25165(c)(3) <br /> Note: All E H D staff time associated with failing to comply by the ahove noted dates will he <br /> trilled at the current hourly rate. <br /> For this certifi cation to be complete, tha operator of the site must include' <br /> A statement documenting what Corrective actions were taken or will be taken for each violation <br /> Copies of sam pie res ultsfmanifestshrainirig recordslofher appropriate paperwork, and lor photos verifying correctlons <br /> Operators certlflcation <br /> Inspection Date: September 17, 2020 Inspected By: ROBERT LOPE <br /> Facility Address. 26250 E GROVES RD, FARMINGTON CERS ID: 10143199 <br /> certify under penalty of law that; <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: <br /> Photos____Paperwork--kstat6rnent <br /> 39 I am authorized to submit this certification on behalf of the Respondent. <br /> 49 I a,rn aware that there are sfgnificant penalties for submitting false information, including the possibility of a fine andk <br /> imprisonment for known violations. (HSC 25191) <br /> Name: "'�i° cvffowo+ Title: <br /> Signature: Date: <br />