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i <br /> : � OANINEnvironmental Health Department <br /> SANC V "TY. <br /> . <br /> RETURN N T COMPLIANCE CERTIFICATION <br /> Any M1NOR violations noted In the"Notioe to Comply'°in the attached Inspection Report rnusf be corredgd witftiin 30 days of <br /> receipt of this inspection. This oertification form must be submitted to tha Environmental Health Department(E HD) address at <br /> the bottom of this foam within 30 days of receipt of the Inspection Deport. HSC 25404.1,2(c)(1} <br /> All corrections to otheyiglatlons 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 fts unless otherwise specified in the <br /> Inspection Report. HSC 25195(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, Lhe 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 sampie resultsfmanifestsAraining records/other appropriate paperwork, and)or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: September 16, 2020 Inspected ey: ROBERT LOPEZ <br /> Facility Address: 10601 LOWER SACRAMENTO FAD, TO N T( CERS ID: 10143469 <br /> certify under penalty of law that. <br /> 1. 1 have corrected the violations specified In the Inspection Report frorn the abova-mentioned inspection date. <br /> 2. t have personally examined the following documentation submitted a,s proof of compliance FCR EACH VIOLATION <br /> and 1 believe the information to be true, accurate, azid complete: <br /> Photos Faperwork_"� taternent <br /> 3. 1 am authorized to submit this certification on behalf of the Responaent. <br /> 4_ lam aware that there are significant penalties for submitting false Information, including the possibility of a fine andfc <br /> irnprisonment for known violations, (HSC 25199) <br /> PWWMW <br /> Name: We: <br /> Signature: Date,, <br />