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Oct 31 22112 : 57p p . 3 <br /> SAN , OAQ U I N Environmental Health Department <br /> T�l`f <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 ( I R) 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 recordsiother appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : September 08 , 2021 Inspected By : CAROL PRESTO <br /> Facility Address : 34243 S CHRISMAN RD , TRACY CERS ID : 10181085 <br /> [ certify under penalty of law that: <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 VIOLATION <br /> and I believe the information to be true, accurate , and complete: <br /> Photos Paperworkt1�S atement <br /> 3 . 1 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 fine <br /> and/or imprisonment for known violations . ( HSC 25191 ) <br /> AISH (4 Title : OW N) <br /> x <br /> Signature : ,( Date : <br /> Utjit„l ryWCE ScS )�LG -(' NOT T j35SIn1rSS pi, 441 i vr4kmFJ710 ,41 inIILI_ # � <br /> J8 9 pAl -t- Vht /J THe, Vic; Tvlit F <br /> lq - I w' 1 � L MA V p Qi, ALL �tETit �', V To corn P14IIAICa df ILT I FIC 4 &TIOr � Qe /LT5 <br /> U) lUU a 5 v 13 �'lVT' i D 04 30 1014 yS <br /> Received Time Sep , 30 . 2021 12 : 42PM No , 6920 <br />