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Environnnenta | &*ealth D*partntent <br />I i.r,, I i'ri .i T <br />II <br />I <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINoR violations noted in the "Notice to comply" in the attached Inspection Report must be plrected within 30 days ofreceipt of this inspection' This certification form must be submitted to the Environmental Health Department (EHD) address atthe 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 (lR) or continuation Form, pr disputes to anyviolations' are to be submitted using this certification and returned to EHD within 30 davs unless otherwise specified in theInspection Report. HSC 251S5(c)(3) <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be billedat the current hourly rate. <br />For this certification to be complete, tne operator of the site must inctude:' A statement documenting what corrective actions were taken or will be taken for each violation' copies of sample results/manifests/training records/other appropriate paperwork, and/or phcrtos verifying corrections. Operator'scertificarron <br />Inspection Date: May 18,2021 Inspected By:JOHN ALANIZ <br />Facility Address:25651N HWY 99, ACAMPO CERS lD: 10181469 <br />I certify under penalty of law that: <br />Signature: <br />1 ' I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2' I have personally examined the following documentation submitted as proof of compliance FoR EACH vloLATloNand I believe the information to be true, accurate, and comolete: <br />-photo. Xruperwork Vstatement <br />/^- <br />3' I am authorized to submit this certification on behalf of the Respondent. <br />4' I am aware that there are significant penalties for submitting false information, including the possibility of a fineand/or imprisonment for known violations. (HSC 25191)