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SAN J 0 A O U I N Environmental Health Department <br /> r :+ t:,l I 'r <br /> RETURN TO COMPLIANCE CERTIFICATION <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(EHE)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 attaches!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 slates 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/man ifestsltraining recordslother appropriate paperwork, andlor photos verifying corrections <br /> Operator's certification <br /> Inspection Date: July 13, 2022 Inspected By: PAUL NSO <br /> Facility Address: 2000 STI MSON RD, STWK ION CI RS ID: 10181267 <br /> i 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 compliance 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: UYX-4re" SL.e L •t Title: S FL <br /> Signatur �, - _Date: 1 T(­�1 2,02,Z <br />