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i <br /> SANIJOAQUI-P <br /> Envir nAntal Health Department <br /> ARM <br /> ` C'wI U N T Y u...w.rnm�me.. <br /> `i ' _ rl rot td° }"ijt. #'Da, <br /> RETURN TO COMPLIANCE CERT( FFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report rr ust be corrected within 30 days of <br /> receipt of this inspection. This certification form must be submitted to the Environmental alth Department(EHD)address <br /> at thetop of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c(1) <br /> All corrections tc other violations noted in the attached Inspection Report(IR)or Continuat on 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 Repo 1. HSC 25185(c)(3) <br /> Note: All EE D staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> ForthiS C reification to be Complete, the operator of the site must incl de: <br /> A statei nent 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 /> correcti Dns <br /> Operat is certification <br /> i <br /> Inspection ate: October 11, 2018 Inspected By: ZUNA BARKER <br /> Facility Add ess: 2420 W TURNER RD, LOyl CERS ID: 10181595 <br /> I certify under penalty of law that: <br /> 1 I have orrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> i <br /> 2j 1 have personally examined the following documentation submitted as proof of cc mpliance FOR EACH VIOLATION <br /> 1 and I believe the information to be true,accurate,andco fete: <br /> V <br /> Photos Paperwork Statement <br /> 3 1 am ai ithorized to submit this certification on behalf of the Respondent. <br /> 41 1 am aware that there are significant penalties for submitting false information,in uding the possibility of a fine <br /> and/ori mpri onmant for known violations. (HSC 2 191) <br /> game: Title: Z-- <br /> Signatur Date: <br /> t <br /> 40 O C U---1+..- A.....,....1 04-1 f.... ng'ln i 1 T OnG ARR_4A,)n 1 9n0 AFA_n1452 1 unen. cinohA rnm <br />