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1 <br /> s <br /> Environmental Health Department <br /> SAN *JQ1 <br /> w � C0UNTY.*, . <br /> � rC :nfr, � ss (� r't3sts ire� �'�'. <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 <br /> at the top 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 <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise 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 <br /> billed 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 <br /> corrections 4 <br /> Operator's certification r\ <br /> Inspection Date : December 14 , 2018 inspected By : LYDIA BAKER <br /> Facility Address : 2605 AUTO PLAZA WAY , TRACY CERS ID : 10207123 <br /> I 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 <br /> and I beiieve .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: 812 �1 n! CE c i Title : ��i'�- 15 7 � dA/ 6 <br /> Signature , _ Date: <br /> 1868 E. Hazelton Avenue ( Stockton, California 95205 ( T 209 468-3420 j F 209 464-0138 1 www. sjcehd , com <br />