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} SAN � � � Environmental Health Department 4 RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address at the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 1 . 2 (c) ( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR ) or Continuation Form , or disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report . HSC 25185 (c)( 3 ) Note : All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete , the operator of the site must include : A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections Operator' s certification Inspection Date : January 31 , 2023 Inspected By : PAUL NSO Facility Address : 15600 S HARLAN RD , LATHROP CERS ID : 10180541 I certify under penalty of law that : 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true , accurate , and complete : Photos Paperwork Statement 3 . 1 am authorized to submit this certification on behalf of the Respondent. 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or imprisonment for known violation ( HSC 25191 ) Name : A Title : Signature : 11 ,4 Date : 03 ) 1 1)