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Environmental Health Department <br /> rR <br /> SANJOAQUIN <br /> CQUNTY— <br /> `,i'�s-.J`,. �rh0:nes5 C�ro�ti3 /1�'ft', <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any yjDR violations noted in the"Notice to Comply" in the attached Inspection Report must be corrected within 3o days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHE)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> Atl 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 dans 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 recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: April 20, 2021 Inspected By: CAROL PRESTO <br /> Facility Address: 9015 WALNUT GROVE RD, THORNTON CERS ID: 10443520 <br /> 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 /> ?, 1 have personally examined the fallowing 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. I am authorized to submit this certification on behalf of the Respondeat. <br /> 4, 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or <br /> imprisonment far known violations. (HSC 25191) <br /> Name: It'! r9-l�1 <br /> Title: <br /> Signature: <br /> F " Date: <br /> OnlinePhotoScanner.com <br />