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��t 31 22112 : 56p p . 1 <br /> M <br /> is �q <br /> SAN JOAQUIN Environmental Health Department <br /> � 0 UN' TY <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MJNOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) 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 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 25165 ( 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 operatorof 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 /> Operato 's certification <br /> Inspection Date : September 08 , 2021 Inspected Ry: CAROL PRESTO <br /> Facility Address : 34243 S CHRISMAN RD , TRACY CERS ID . 10181085 <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 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 /> 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 : f�A �( 3 .� rS � Title : <br /> Signature : 1Q� i�v�WC� ( '� ` Date : - 1 d I <br /> RECEIVED <br /> SEP 3 0 2021 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> Received Time Sep . 30 , 2021 12 : 42PM No . 6920 <br />