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i <br /> SAN OEnvironmental Health D p r� merit <br /> RETURN To COMPLIANCE CERTIFICATION <br /> Aeay fNt7f% vi€ lzafxsrt<; rtr,t d is the NoPl o to Comply' In the olt:anc�€ 11 l Isp , d=)fctrtrtt _ of <br /> rc Ceipt of thi<a inSpev .11ora f his cerfalirration four trio ' bra =„ hlulltod to fir=? Fnvir9rr "thrill;d Hl ( f" ID xa .4 .3rlia at <br /> taao hcsttorn of this ftrrrel within aft days of mceipt of th€ . Insiw0ion Rcapurt . NSC 25404A . 2(€;)( 1 ) <br /> Allca rfc0 i (,LDSJO ratlpt { violations noted in the :attached Inspection Rel;=fart ( iR ) or C ontinuration Forfar , or d1sput€; s to Karry <br /> violations , arra to he submthed using this ceffification arid rettarned to D1D av_itt;ti [ 5 , 10 day aanl€ ss othcn#�i�e sperified in the <br /> Inspection R€;port_ HSC 25185(, )( 3 ) <br /> Note : All EHD staff time associated with tailing to comply by the above noted dates will be � <br /> billed at the current hourly rate , <br /> For this certification t0 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 sarople resultsilel anifell4tJ raining reccordstother appropriate paperwork , sand/or pholosi verifyFng rnrreclioris <br /> Operator ' % cc rfificati€art <br /> Inspection Date : April "114 , 2022 Inspected By : CAROL PRESTO <br /> Facility Address : 24572 S MACARTI-IUR , TRACY CERS lid : 10137493 <br /> I certify under penalty of lave that: <br /> 1 , f have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . <br /> 2 . 1 havo 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 XPaperwork 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 . ( NSC 25191 ) tt�� <br /> Dame : Title :. <br /> Signature : _Date : <br /> RECEIVED <br /> MAY 13 2022 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />