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SAN J O AQ U N Environmental Health Department <br /> Count <br /> • t•f�r1[fTSS 4�nK� <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 /> freceipt 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 hates 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 resultsimanifestsltraining records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: February 15, 2022 Inspected By: CAROL PRESTO <br /> Facility Address: 25775 S PATTERSON PASS RD, TRACY CERS 1D: 10181249 <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. 1 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 /> Name: '1 �T�— Title: <br /> Signature: Date: Z I t f 2`'2 Z_ <br />