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SAN 10 A Q U I N Environmental Health Department <br /> C C t N T Y received 6/ 13/2024pn <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 (EHD ) address at the <br /> 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 violations , <br /> are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection <br /> 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 : May 03 , 2024 Inspected By : STACY RIVERA <br /> Facility Address : 950 W ELEVENTH ST , TRACY CERS ID : 10182093 <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 following documentation submitted as proof of compliance FOR EACH VIOLATION and <br /> I believe the information to be true , accurate , and complete : <br /> Photos Paperwork V Statement <br /> 3 . I 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 and/or <br /> imprisonment for known violations . ( HSC 25191 ) <br /> Name : Ashley Nimmo Title : Environmental Compliance Consultant <br /> Signature : AghZ& uW Date : 6/ 13/24 <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 I T 209 46&3420 I F 209 464-0138 1 www. sjgov. org/EHD <br />