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SAN JOAQUIN Environmental Health Department <br /> e�- OU 1T <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR viorations rioted in the LLNotice toComply" 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 Healthy Department (EHD) address at <br /> the bottom of this form within 3 0 days of receipt of the inspection report. HSC 2 5404,12(c)(1 ) <br /> All correcUons to other violations noted in the att shed Inspection Report (IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this certification arta returned to EHD Mhin 30 days unless otherwise specified in the <br /> Inspection Deport. HSC 25185(c)(3) <br /> Mote: All EHD staff time associated with failing to comply by the above noted darter 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 staternent documenting what corrective actions were token or will be taken for each violation <br /> Copies of S aimple re ultslmanifestsArairifng recordsfother 2ppropriate paperwork, and/or photos verifying corrections <br /> Operator's oertiffcation <br /> Inspection Date: March 31 , 2021 inspected By: CAROL PRESTO <br /> Facility Address: 2615 W GRANT LIME FAD, TRACY CERS ID: 10184725 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date- <br /> 1 l have persorralfy examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to he true, accurate, and complete: <br /> .. Paperwork <br /> PhotosStatement,�. -- <br /> - 1 am authorized to submit this oertification 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 191) <br /> frn �;' C /11 / Title: <br />