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i <br /> _. <br /> SAN <br /> N Environmental Health Department <br /> t ��s 9r0w5 herr <br /> re <br /> AnyRETURN TO COMPLIANCE CERTIFICATION <br /> the pt Of this °iIons <br /> bat' <br /> in the <br /> 0ftorn°f thisp 0�ti°nnoted is certification footice to Comply, in the attached Inspection Report must be corrected within 30 ftLs of <br /> All m within m must be submitted to the Environmental Health Department(EHD)address at <br /> °orre� • 30 days of receipt of the Inspection Report. HSC 25404.1.2(c)(1) <br /> �i0lationstia�es to other violations noted in <br /> InspeCti° t0 be sub the attached Inspection Report(IR)or Continuation Form, or disputes to any <br /> Repot H, mitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> C 25185(c)(3) <br /> Nate: <br /> All EHp staff time associated with failing to comply by the above noted dates will be billed <br /> at the current hourly rate. <br /> For this Certificate <br /> A State Ion to be complete, the operator of the site must include: <br /> ment documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: November 23, 2020 <br /> Inspected By: PAUL NSO <br /> Facility Address: 1330 E YOSEMITE AVE, MANTECA <br /> CERS ID: 10184191 <br /> 1 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 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, 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: <br /> / Title: <br /> Signature <br /> Date: ��/ oh;7 <br />