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Environmental Health Department <br /> SH-JOAQUIN <br /> C _`UNTY 4 # <br /> 4 F <br /> 1 L_ <br /> 11 f' fl( <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR-violations-noted in the"Notice to-Comply'in theattached lnspeetionReport-must-be corrected within 3U 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 /> 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 <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: July 08, 2022 Inspected By: PAUL NSO <br /> Facility Address: 515 W ELEVENTH ST STE 801, TRACY CERS ID: 10181209 <br /> 1 certify under penalty of law that: <br /> 1. I 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 compliance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,and complete: <br /> Photos PaperworkStatement <br /> 3. 1 arra authorized to submit this certification on behalf of the Respondent <br /> 4. 1 am aware that there are significant penalti®s for submitting false information,including the possibility of a fine and/or <br /> imprisonment for known violations. (HSC 25191) <br /> Name: ('c Title: <br /> Signature: Date. It Z. <br /> ,We . <br />