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, EB / 25 / 2022 / FRI 04 : 05 PM Tracy Truck Stop FAX No . 209832 2312 P . 001 <br /> : } Environmental <br /> Healt Department N. <br /> d. <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 /> 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 co r ions 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 : Februa 22 , 2022 Inspected By : CAROL PRESTO <br /> Facility Address : 3775 N TRACY BLVD , TRACY CERS 1D : 10181337 <br /> I certify under penalty of law that: <br /> 1 . ( 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 V 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 tine <br /> and/or imprisonment for known violations. (HSC 25191 ) <br /> Title : D...Q KM, <br /> Signature: I � �1 Date : <br /> RECEIVED <br /> FEB 2 5 2022 <br /> FNVIRONMENTAL HEAL1 H <br /> PERMIT/ SF. VICE > <br /> Received Time Feb . 25 . 2022 4104PM No , 7114 <br />