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RECEIVED BY EHD: <br /> 5/20/2021 at 10:09pm <br /> SAN 10AQUIN Envir via email <br /> )UNI Y <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 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 /> Copies of sample results/manifests/training records/other appropnate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: April 22, 2021 Inspected By: CAROL PRESTO <br /> _ Facility Address: 24323 N HWY 99, ACAMPO CERS ID: 10181611 <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 /> 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 /> Photosy Paperwork / Statement <br /> 3 1 am authorized to submit this certification 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: � (Y) r I T SQnU 11 Title: 1 ► ►QY1 a <br /> Signature:_ Date: 5I2-c j 2 <br />