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04 / 26 / 2019 16054 5107963470 SHARP9A PAGE 04 <br /> 4r Aki,.r,� r EnAronlmentai Wealth Department <br /> 21P <br /> I 3k40r <br /> t 2114 .. : <br /> sfrj? it�,. a <br /> i aufiEl~ d ? ' : . 9� p �R • i�dv :,44 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply" 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 Environmental Health Department (EHD ) address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404 , 1 ,2 (c)( 1 ) <br /> All corrections to other violations noted In the attached Inspection Report (IR) or Continuation Form , or disputes to any <br /> violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note : All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate . <br /> For this certification to be complete , the operator of the site must include . <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> (.npiac of camnla ramdtc/manifactc/training rarnrrlc/nthAr appmpriatP paperwnric . and /nr phntns vorifyind <br /> corrections <br /> Operator's certification <br /> Inspection Date : March 27 , 2019 Inspected By : ZUNA BARKER <br /> Facility Address : 1100 S MAIN ST,. MANTECA CERS On 10182243 <br /> I certify under penalty of law that. <br /> 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date , <br /> 20 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 Statement <br /> 3 . 1 am authorized to submit this certlficatlon on behalf of the Respondent, <br /> 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191 ) <br /> Name : �.Vlr � 41A�LYVI �k Title : 19 pt <br /> Signature : �lJ�-�.tn- O � Date : -- <br /> LIV UD <br /> APR 2 9 2019 <br /> F, NVIRONNILNTAL HEAL'T' H <br /> I) I,. P,k RT lei ENT <br /> R e c e 1 v e d T i me EAP r , 26 , 12 019' 6 : 5 2 P NhrN o , 4 9 7 0a 952051 T 209 468,34201 F 200464-0138 1 www , sjcehd . com <br />