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Environmental Health Department <br /> SAN JOAQUIN <br /> CC) UN , <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> y MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> :eipt of this Inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address at <br /> a bottom of this form within 30 days of receipt of the Inspection Report. NSC 25404. 1 . 2(c)( 1 ) <br /> I corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form , or disputes to any <br /> dations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> spection Report. HSC 25185(c)(3) <br /> tote : All END staff time associated with failing to comply by the above noted dates will be billed <br /> at the current hourly rate . <br /> : or 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 : June 16 , 2021 Inspected By : PAUL NSO <br /> Facility Address : 1711 E Yosemite Ave , Manteca CERS ID : 10422475 <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 /> 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 /> 4 . I am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonm <br /> ent for known violations . (HSC 25191 ) <br /> Name : a Title : t_-e o <br /> Signature : l/ �� Date : <br />