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A 3J O A Q U I N Environmental Health Department <br /> COUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the'Notice to 0=ply" in the attached Inspection Report must be porreptr,d within 30 da}s of <br /> receipt of this inspection. This certification form must he submitted to the Environmental Health Department(E HD) address at ; <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSG 25404.1.2(o)(1) <br /> All corrections to other violations noted in the attached Inspection Report (IR)or Continuation Farm, or disputes to any <br /> violations, are to be submitted using this rertificalion and returned to EHD within 30 day 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 he <br /> billed at the current hourly rate. <br /> For this certification to be cornplete, the operator of the site must include; <br /> A statement documenting what corrective act ions were taken or will be taken foT each violation <br /> Copies of sample res ultslm an i restsArs i ni ng recordsfathor appropriate paperwork, and/or photos verifying carrecllons <br /> Operator's certification <br /> Inspection Date. September 16, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address: 2853 Saxton DFS, 6 tockton CERS ID: 10145389 <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 person WN examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe 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. lam aware that there are significant penalties for submitting false Information, including the possibility of a fine andh <br /> imprisonment for known violations. (HSC 26191) <br /> Name: ccrr "° Title: <br /> Signature: bate: <br />