Laserfiche WebLink
" . .. Environmental Health Depart art <br /> SMACAMN <br /> CUNT`{ <br /> ?4: 1��r*1 } <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIt+-QIP Vial�itiorfs nat6d+n the"Notioe to comply' in titre ;ftohq�d fnspecUm Repot must ba p-:x ¢edgj hln 30jjay,� of <br /> receipt of this inspection- -(his certlfiraWn form must be suhmrtted 0 tie EnWorffpa nal 1-tealb Department(EHD)address at <br /> the bokt❑rn at khts form within N(Jays of receipt of the trrspec m Rpt HSC 25404.9-2f c)(1) <br /> All carr cti s oth v'o nates rs t#fie$t rhwd lr)spp, an Report(1R)Or GunflnuaGon Form, or oispukes to any <br /> viofalfons, are 0 W subrrr lw vs this cer1iFC0finn anti rekurned Lo EN D wHh�rr 30 days unless oth$rwise specified in Che <br /> fnvar6lrilR696�#. HSG251we)(3) _ — <br /> Note: All END staff tirxre associated with#aitiing to colmply by the above noted Matas will be bfUed <br /> at the coawt hourly rate. <br /> For this cedificattan to be CoMplete, the opetetor of p*skb nvsl:i Wilde: <br /> A slakemeat documenting what criwective anUo ris were taken or vA be taken for BE10 vblalion <br /> copla;of sample resutl Snffes(wwair*r g reccMWotkw appx"to peparwor9c,ar)dlcr photos verifying c4rrerdions <br /> Operakovs Ck RKrLcaiiun <br /> Inspection Dmfs: Au9jist 2D, 2 020 inspected By: N(CHOLAS LOEHRER <br /> Facility Address: 609WSIXTH ST, TRACY CERS ID: 1014$527 <br /> 1 certify under penalky oRavw ft► <br /> :. <br /> 1. i have oDrrecited the WoPabms Vod%d ire the l nspecMn Report frons the above-nrt E)nklvned in"ackion date- <br /> 2. 1 flava pernorrally examined th@ kollowirV documentation 3ubnnlged as W10 of contp#ianoe POR EACH VJO ATtON <br /> i <br /> and I Wieve the information to be true,aGcxirate, and compieto: <br /> photos- _ PspWv Vk<SW112tment <br /> I <br /> 3, f aM authadzed W subanit Ws ?ifica4fon an babWf of th93 Rasporllertk <br /> 4, 1 am aware that there are signiflc�knt penalties for�.ubtr,Wng false inlormaOon, rftd tog the asiMly of a fine <br /> andtar imp6sorLmenk for knuu rm Aolaklons, (HSr,2ti 191) <br /> Name: TMa- <br /> i <br /> Sinaln�a: nate: <br /> s <br /> 4 <br /> } <br /> i <br /> f <br />