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ANrJOAQUIN Environmental Health Department <br />.COUilTY <br />kr.:fti.., ,,, .- .. <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be gorrected wn 30_s of <br />receipt of this Inspection. This certification form must be submitted to the Environmental Health Department (EMD) 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 {IRj or Continuation Form, or disputes to any <br />violations, are to be submitted using this certiflcation and returned to EHD within 30 days unless otherwise specified in the <br />Inspection Report, HSC 25185(o)(3) <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />baled at the current hourly rate, <br />Far 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: April 29, 2021 inspected ey: CAROL. PRESTU <br />Facility Address: 2895 N NAGLEE RD, TRACY CERS !D; 1018449 <br />I certify under penalty of law that; <br />'I. P <br />i have corrected the violations specified in the Inspection Report from the above=mentioned inspection dato. <br />2. I 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 V$ <br />Paperwork 'Statement <br />3.. I am authorized to submit this certification on behalf of the Respondent, <br />4. tam aware that there are significant penalties for submitting false infarmatlorr, including the possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191} <br />Name: B <br />Tlfle: 5; cP-t1 s cis bt A AFC-�7a2 <br />e ta;: yl' �All <br />MIaY 1 3 2021 <br />ENVIRONMENTAL HEALTH <br />.a. DEPARTMENT <br />