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SAN J AQUIN Environmental eallin Department <br />R�3'El�R'P6 3d Cd'Pd6Q1�tiA'P6�� ��R3ti�ti�A'{i'tid'N� <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be connected within 30 days of <br />receipt of this inspection. This certifrcadon form must be submitted to the Envkurrrnentaf Heafth Uepiarftnent (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 anv <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 notred dates will be <br />billed at the current hourly rate. <br />Far 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 violatiion <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br />Operator's certification <br />Inspection Date: March 08, 2022 <br />Inspected By: CAROL PRESTO <br />Facility Address: 1131 HOLLY DR, TRACY CERS ID <br />I certify under penalty of law that: <br />10184261 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioneid inspection date. <br />2. I have personally examined the following documentation submitt <br />ed 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. I am authorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there are significant penalties for submitt <br />ing false information, including the possibility of a fine <br />anci)or'imprisonmen't fior'Known Jioiations. ('fisc 2b'I�'1') <br />Name: 7�24Gi; /2 Title: 1,:9�%'zj�, i � i2 sWrvi?y /�r4o.1 <br />Signature:, <br />Date: iGf4 2 j, 2C, Z Z, <br />APR 0 7 2022 <br />ENVIRONMENTAL HEAL <br />DEPARTMENT <br />