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Jan 06 22 12 : 26p Payless Auto Repair 209-334-3115 p . 3 <br /> Environmental Health Department <br /> SAW] DANIN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to CompV 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, HSG 25404 . 1 .2(c)( 1 ) <br /> All 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 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br /> Note: All EHD staff time associated with failing to compiy by the above rioted dates will be billed <br /> 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/manifestslfrainIng recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: Decem, ber 02 , 2021 inspected By : VICKY VANG -LEE <br /> Facility Address: 26 N CHEROKEE LN STE t3 , LODI CERS 1D: 10182347 <br /> 1 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. 1 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 — _ - -_-- Paperwork _ ". " _ . _Statement <br /> 3. 1 am authorized to submit this certiftcation on behalf of the Respondent. <br /> C lam aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> andlor imprisonment for known violations. (HSG 25191 ) <br /> NamesfJ ,L lLl� Title : �� ��t1 � � ✓ <br /> Signature ; Date_ 0 t 3%nor I � <br />