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SKJOAQUIN <br />Wk <br />,, ,�'� Greotness grows here. <br />Environmental Health De <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the ' Notice to Comply" in the attached Inspection Report must he corrected within 30 days <br />receipt of this inspection. This certification form must be i;ubmitted to the Environmental Health Department (EHD) addres <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 dates will be billed <br />at the current hourly rate. <br />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 correctio <br />Operator's certification <br />Inspected By: JOHN ALANIZ <br />Inspection Date: April 26, 2022 <br />Facility Address: 9015 WALNUT GROVE RD, THORNTON <br />CERS ID: 104435201111111 11111 1111111 MEN MEN NONE <br />G <br />I certify under penalty of law that <br />I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIC <br />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork X Statement <br />2. <br />4. <br />I am authorized to submit this certification on behalf of the Respondent. <br />I am aware that there are iin violations. ficantpenalties <br />for <br />sub <br />Manager <br />submitting false information, including the possibility of a fine <br />and/or imprisonment for known <br />Name: <br />Signature <br />Title: <br />Nasim Tarin <br />