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FA) E T` 9099 "N WdO :: I606 8l 'qad omit paAl ;D;d <br /> r =,: Environmental Health Department <br /> '�:a�i._•,'s;., +�wist;dRx�:�:�r?�:!'r';'L1Y:;tii�W�!s„.:'.�'t�'T;l'�': <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 at <br /> the bottom 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 Repoit. HSC 25185(c)(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 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 /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: January 25, 2021 Inspected By: PAUL NSO <br /> Facility Address: 341 E MAIN ST, RIPON CERS ID: 10181381 <br /> I certify under patty of law that: <br /> GI have corrected the violations specified in the Inspeclion Report from the above-mentioned inspection date- <br /> 2. 1 have personally examined the following documentation submitted es proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> I am authorized to submit this certification on behalf of the Respondent. <br /> 4. lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25181) <br /> �- <br /> Name: A- til Title: t P0% <br /> t <br /> Signatu Date: _ <br /> REC !VEL <br /> FEB 18 mi <br /> ENVIRONMENI,-,L L it <br /> PERMIT/SER,v,,___ <br />