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�. S AN � Environmental Health Department <br /> { ?' x <br /> 0 CO NTY—T <br /> crrvtness grows Bete. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN violations nflted in the"Notice to Comply' in the attached Inspection Report must tie corrected within 30 days of <br /> receipt of this inspechan This certification form must be submitted to the Environm@ntal Health Department(EHD)addfess at <br /> the batlom of this form within 30 days of receipt of the Inspection Report. H C 25404.1.2{c)(1) <br /> All corrections to other violations noled In the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> viol alions, are to be submitted using this cerlification and returned to EH within 30 days uniess otherwise specified in the <br /> Irfspect:on keport HS0 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 ras ultg."nAf stsltraining reoordsfother appropriate pape+wofk, andlor photos verlfymg corrections <br /> Operators cadificatian <br /> Inspection Date., February 27, 2024 Inspected By,. VICKY AN -LEE <br /> Facility Address: 1002 FRONTAGE RD, RIPON CERS ID, 10150637 <br /> I coolify under penalty of taw That. <br /> 1. I have corrected tie violat1ons specified in the Inspection Report From the above-mentiQned inspection date- <br /> 2 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOtATI N <br /> and I believe the information to be true, accurate, and complete: <br /> Photos Papenmark Statement <br /> 3. f am authorized to submit this certiAcation on behalf of the Respondent <br /> 4. I am aware that Vlore are significant pen$Ities for submittirLq false inforrnalion, including the possibility of a fine <br /> undlor imprisonment far known violation$. (HSC 25191) <br /> !Name; Tom Sabers Title: S+r , <br /> SIgnatUre: - Date: C05 D ti "LT <br />