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RECEIVED <br /> E.-ov'ivorkrnental He ia <br /> Wir�i <br /> S A W 10AOU IN <br /> a 1':NVIRONNIENTAL 1IL'ALTH <br /> IENT <br /> RETURN TO COMPLIRNCO*E 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(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 Continuatior Form,or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless utherwise 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;nclude: <br /> A statement documenting what corrective actions were taken or will be taken for each v-olation <br /> Copies of sample results/manifests/training records/other appropriate paperwork.and/or phoios verifying corrections <br /> Operator's certification <br /> Inspection Date: February 16, 2023 Inspected Ey: KRISTINA SAETERN <br /> Facility Address: 1329 Escalon Ave. Escalon CERS ID: 10746523 <br /> 1 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 follow!ng documentation submitted as proof of co- pliance 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: -jot, birNaAdO, Title. LQ017 a- er <br /> Signature: _— _Date: -2 I �� -----____-- <br />