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SAN JOAQUIN Environmental Health Department C":, .t il�7 I . . . RETURN TO COMPLIANCE CERTIFICATION AnyIM NOR violations noted in the "Notice to Comply° in the attached Inspection Report must be corrected within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental Health Department ( EHD) address at the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404. 1 .2 (c)(1 ) All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any violations, are to be submitted using this certification and returned to EHD within 30 dais unless otherwise specified in the Inspection Report, HSC 25185(c)(3) Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete , the operator of the site must include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections Operator's certification Inspection Date : January 25, 2021 Inspected By: PAUL NSO Facility Address : 816 E FRONTAGE RD , RIPON CERS ID: 10181513 I certify under penalty of law that: 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date, 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate , a d complete: • / Photos Paperwork ^' Statement 3 . 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations . (HSC 25191 ) Name: Title: / ry� Signature: Date: /g ��