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,�_,� _ Sp t,,��O (tnU� t[, Environmental HealtFi Department <br /> [s�.�_- - _H lCY9V 3Ni T4V-1`L <br /> .-.;- _ Greo rn ess grows here. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in[M1a�Nottce to Comply"to[M1a attached Inspection Report mVat bo a ectad wi[M1 n 3O days of <br /> calpt o£tryls inspac[idn- Tbia cartlflcatlon form mos[ba submitted to trya EnNronmantal Haal[h Department(EHO)address a[ <br /> the bottom of tM1is form wltnin 30 days of receipt oT Iha Inspaotlon Report. HSe 25404-'1-2(c)('I) <br /> All noted In iha attacryed Inspection Report(I R)oY Continuation Fprm. or disputes to any <br /> violation a to be ubmlttad using tM1la cartlflcatlon and ra[umad Lo EHO w[M1 n 30 days unless otherwise spacl£ad in tM1a <br /> Inspection Report. HSC 25'185(c)(3) <br /> Not¢: All EHE ataH time asaoclatad with 4aping Lo comply by tit¢ above noted dates will ba billed <br /> a[Lba current hourly rata. <br /> For this certification to be. com pieta, me operator or me site m.,et mdade: <br /> A statement documenting wM1a[c recLva actions Wara faxen o will ba faxen£or eacM1 vtolatlon <br /> - Copies of sampler ults/manifests/[ralning records/other appropriate paparworK.and/or pryotos verifying correotions <br /> - Operator's cartlflcatlon <br /> Inspection Oat¢: September 27, 2029 Inspected By: PAUL NSO <br /> Fac111ty Address: 9 930 N MAIN ST, MANTECA GERS ID: 10'189367 <br /> 1 certify under partalty o£law tryst <br /> t- I have corrected the vlola[iona specified In the Inspection Report from[M1e above-mentioned Inspact(on data- <br /> 2_ i M1ava personally a mined the T011owing documentation submitted as proof oP compllanoe FOR EAGH VIOLATION <br /> and I believe trye Information to ba truce, accurate.and compute: <br /> K Pryous � PaparvvorK K- Statement <br /> 3- 1 am authorlmad[o submit[M1ls c¢nlff<SaSon on behalf oT trye Raspondan[- <br /> 4. i am aware that fryers are s19ni8cant penalties forsubmitting faisa Information, inducting the possibility of a floe <br /> and/or imprisonmani for known vloiatlons. (H8C 25'19'1) <br /> Name- 6$�[(L-T Gf}$/ll��`> I-I TiLa- � oa+p?utf 7K.f1Ui.V(r ri�i¢NkG LQ <br /> Signa[ � � ( Uafe' to/ZS J2dZ <br />