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SAN JDAWN Environmental Health Department h t. 3 RETURN TO COMPLIANCE CERTIFICATION Any MINOR 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 days 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 : September 13 , 2021 inspected By . PAUL NS-0 Facility Address : 440 W DR MARTIN LUTHER KING JR BLVD , S CERS ID : 10180903 certify under penalty of law that: 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and 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 : r Signature : Date , �)