Laserfiche WebLink
FEB / 25 / 2022/FRI 04 ; 06 PM Tracy Truck Stop FAX No , 209832 2312 P , 006 <br /> t Environmental Health Department <br /> " ': 1 <br /> �� p <br /> 061, <br /> •,]'�•Biliv$: i.in,'<��. �.:},:j:: <br /> ` sr, <br /> . . . . . : ... . . . . . . <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINER violations noted in 'the "Notice to Comply" In the attached Inspection Report must be gorracted within 30 daLs 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 (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 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 records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : February 22 , 2022 Inspected By : CAROL PRESTO <br /> Facility Address : 3775 N TRACY BLVD , TRACY CERS ID : 10181337 <br /> Pon <br /> I 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 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 25181 ) <br /> Name : ` � ingAl> 1 in-C cltk Title : rp., <br /> Signature : i' _ j ` Date : Z- Z�s <br /> Received Time Feb , 25 ` 2022 4 . 04PM No , 7114 <br />