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r <br /> SKJOAQUIN Environmental Health Department <br /> COUNTY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR Violation$ noted in the"Notioe to Comply' in the attached Inspecfion Report must be corceted wfthi a s of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHQ address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other y4lations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br /> violations. are to be submitted using this cert1ication and returned to EH WHOOn 30 dan 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 rioted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting v&at corrective actions were taken or will be taken for each violation <br /> Copies of sample res ultslmanifestsAraining recordslother appropriate paperwork, andfor photos verifying corrections <br /> Operator's certification <br /> Inspection Date: September 16, 2020 Inspected By: ROBERT LOPEZ <br /> Facility Address., X415 FEATHER RIVER DIS, STOCKTON CERS ID: 10641504 <br /> 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 personally examined the following documentatlon submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and cornpiete: <br /> Photos!Paperwork� taternen t <br /> 3_ 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4_ 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and)( <br /> imprisonment for known violations. (1-180 2519 1) <br /> Affmid ONp rrlmfwwLI oamOwma <br /> Name- Title: <br /> signature; _ Date; _ � � <br />