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JAGK ' S TRANSMISSION REP . 209 - 823 - 3058 p . l <br /> SAN JOAQUIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply" it) the attached Inspection Report must bo corrected within 30. clayn. of <br /> receipt of this inspection . This certification form must be submi#gid to the Environmontal Health Department ( EHD) address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404. 1 . 2(1)( 1 ) <br /> All corrections to other violations noted in the attachT d Inspection Roport ( IR) or Continuation Form , or disputes to any <br /> violations, aro to bo submitted using this certiticntion and returned to EHD within 30 drtvs unless otherwise specified in the <br /> in^,poction Roport. 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 oprrstor of the sito must include: <br /> A statement documenting what Corrective actions were taken or will be taken for each violation <br /> Copus of tiample results/manifests/training recordslother appropriate paperwork, end/or photon, verifying corrections <br /> Operator's certification <br /> Inspection Date : March 07 , 2022 Inspected By : PAUL N80 <br /> Facility Address : 276 MOFFAT BLVD , MANTECA CERS ID : 10186678 <br /> I certify under penalty of law that: <br /> 1 . 1 have corrected the violations specified in the Inspection Report from the above-Itlentioned Inspoction dato , <br /> 2 . 1 havo por nonaliy oxamined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the inforrnation 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 3m aware that there are significant penalties for submitting fnlso information , including the, possibility of a fine <br /> and/or imprisomnont for known violntion,. (HSC 25191 ) <br /> Name : K W t c. t, ( r j ' Title: <br /> r O <br /> Signature: ��-•���.�'..�?e�' etc : . ...`' _ ,.n. .,..r ..,� <br /> ORIECENED <br /> MAR 10 2022 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />