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SAN J 0 A Q U I N Environmental Health Department <br />C OUNiY <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be correc ed 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 />All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or cisputes 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 />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: <br />Facility Address: <br />January 26, 2022 <br />22844 S FREDERICK RD, RIPON <br />I certify under penalty of law that: <br />Inspected By: KRISTINA SAETERN <br />CERS ID: 10186549 <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned in:;pection 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, acute, and complete: <br />� Photos Paperwork V Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />I am aware that there are significant penalties for submitting false information, including the p-)ssibility of a fine <br />and/or imprisonment for knownvi lation . (HSC 25191) <br />Name. <br />l �U i Title: ' A) L /L <br />Signature: / Date: <br />RECEIVED <br />FEB 14 2022 <br />EN 1'EI20N IE'NT,k1,11i:<;icl'lI <br />I)E RAiiTNIlr`r"ti'T <br />