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SAN JOAQUIN Environmental Health Department <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in <br />the "Notice to Comply° <br />in the attached Inspection Report <br />must be corrected within 30 days of <br />receipt of this inspection. This <br />certification form must <br />be submitted to the Environmental <br />Health Department (EHD) address at <br />the bottom of this form within 30 days of receipt of the <br />Inspection Report. HSC 25404.1.2(c)(1) <br />All comecticns to other violations noted in the attached Inspection <br />Report (IR) or <br />Continuation Form, or disputes to any <br />violations, <br />are to be submitted using this certification and returned <br />to EHD within <br />30 days unless otherwise specified in the <br />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 <br />billed at the current hourly rate. <br />For this certification to be complete, the operator ofthe 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 />June 26, 2025 <br />Inspected By: MONICADEANDA <br />5749 S TRACY BLVD, TRACY CERS ID: 10183017 <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. I have personally examined the following documentation submitted as proof of compliance FOR EA <br />CH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />3. I am authorized to submit this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitt <br />ing false information, including the possibility of a fine and/or <br />imprisonment for known violations. (HSC 25191) <br />Name: Title: Airport Manager <br />Signature: )Oau^^ <br />& � 44444 o7- Date: September 26, 2025 <br />