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S Q N O Q Q U N Environmental Health Department At : r . , . ETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the " Notice to Comply " in the attached Inspection Report must be corrected within 30 days of receipt of this inspection . This certification form must be submitted to the Environmental Health Department (EHD ) address of the bottom of this form within 30 days of receipt of the Inspection Report HSC 25404 . 1 . 2(c)( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR ) or Continuation Form, or disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report, HSC 25185(c)(3 ) Note : All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate . For this certification to be complete , the operator of the site must include : 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 photos verifying corrections Operator's certification Inspection Date . January 04 , 2022 Inspected By: PAUL NSO Facility Address : 26722 S HANSEN RD , TRACY CERS ID : I certify under penalty of law that: 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: Photos Paperwork Statement 3. 1 am authorized to submit this certification on behalf of the Respondent 4. 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or imprisonment for known'/violations. ( HSC 25191 ) n Name : tib/ Title : CA E 0 Signature : ! �� Date : d lL zS I7iD Z Z i II