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S A N O A Q U I� NEmmhmuniental Heath Department <br /> RETURN TO COMPLIANCE CERTIFICAVION <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 /> Al corrections to other violations noted in The attached Inspection Report (1R) 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: March 08 , 2022 Inspected By: CAROL PRESTO <br /> Facility Address: 1131 HOLLY DR , TRACY CERS ID : 10184261 <br /> 1 certify under penalty of law that: <br /> 1 . 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 compliancea. 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 : / C�� S ZZZ Title :aK /.,.vT 152 � <br /> 2 Orv,20 l-�04oVe <br /> 1.k <br /> SignaturDate : <br /> e : <br /> � �l <br /> RECEIVED <br /> APR 0 7 2022 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />