Laserfiche WebLink
i <br /> r t <br /> SAN J O QQ U I N Environme Department <br /> _ I ' <br /> tb <br /> ElVED <br /> r <br /> - COUNTY -- <br /> �',� Gr $ a ► l ', r : , ( It , , . heIc . <br /> SEP Z 7 2021 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> ENVIRONMENT) <br /> NME <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be correcte NrQM HE, <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD) a�NT <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 violations 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 days 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 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 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 : April 26 , 2021 Inspected By : PAUL NSO <br /> Facility Address : 1001 E YOSEMITE AVE , MANTECA CERS ID : 10180593 <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 personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true , accurate , and <br /> ` 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 : AsA Title : (� " <br /> Signature : Date : <br /> I <br />