Laserfiche WebLink
S A N X10 A Q U IN Environmental Health Department <br /> COUNTY <br /> Greotriess grows Dere, <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR 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 Inspect on 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 resultslmanifestsltra ning records/other appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: October 24, 2019 Inspected By: ELIANNA FLORIDO <br /> Facility Address: 2475 Naglee Rd, Tracy CERS ID: 10664632 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violat ons specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of co pliance FOR EACH VIOLATION <br /> and I believe the information to be true,a- <br /> and and comply 7 <br /> Photosy 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 and/or <br /> imprisonment for known viola ions (MSC 25191) <br /> Name: Q�ef"1 n' G�� Title: f (_C9 M P� 64\4C rl)Jr, <br /> Signature: ate: 7 1 <br />