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SANJO M Environmental Health Department <br /> C= OUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MING violations noted In the"Notioe to Comply' In the attache)InspeUiari Report must beoa.�r ectad wilhir�s0 days of <br /> receipt IN%k7*ectron. Thior€dificatian levy)mstbe sutxrnitied t0 the Environmental Health Department(E HID)addfess at <br /> the bottom of this fDrm within 30 days of receipt of the Inspection Report. HSC 25404.1.�(c)(1) <br /> ,all correctihn to other violallons noted iri the attached Inspectian Repori.(IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this eartlficaUon and retumed to EHC within 30 days unless otharmse specified in the <br /> fnspeclionRaparl. HSG 2Ef85(cX3) <br /> Note: All E H D staff time associated with falling to comply by the above noted dates vuiII be billed <br /> at the current hourly rata. <br /> For this certification to be complete, the operator of the site musk include; <br /> A statement docu menfing what corrective actions were taken or will be take n for each vi(ilatlon <br /> Copies of sample resultsimanifestsltraining ri�)oordslother appropriate papenvork, andfor photos verifying corrections <br /> Operalars cerdfication <br /> Inspection Date: August 20, 2020 Inspected By: NICHOLAS LOEHRER <br /> FacilitY Address; 101 SLOAN OT, TRAY CER ID: 10145279 <br /> 1 certify uhder penalty of law that <br /> 1, 1 have corrected the,vjdakn�specified in the Inspection Report from thts above-mentioned inspecGar,date. <br /> 2. I have personglty examined the fallowing documentation aubmltted as proof of compliance FOR EACH ViolATION <br /> find I believe the inforrnaUon to be true, aocmrate, and complefe'. <br /> photos _Paperwork "-'�Statement <br /> 1 1 am au thorizad to submit this certification on behalf of ih2 Respondent. <br /> 4. 1 om aware thzit there are significant penalUes for subrnitting false Informalkn,including the possibility of a fine <br /> and/or Imprisorrmant for known violations- (HSC 25199) <br /> Narne: Title: <br /> Signature. Date: <br />