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AUG/18/2021/WED 03: 19 PM Tracy Truck Stop FAX No, 209832 2312 P, 009 <br /> .,• <br /> ii;,i:;i jai'-I:';i. <br /> h� <br /> Environmental{. Health <br /> ntal Department <br /> �..� 1 1.: i1.i ,. I I 'iii� {.,I•:i I:��:;is <br /> I� !il1i��� ""II.�!� I,,�IrT7r}S�r�•MI�i i.:¢ ii <br /> 11 �i + �1:�:.l::ri:l.'i l"w,',ai :�l�,..!.I;`M''M`i�;• <br /> li;ji:a:�+•s •r'�t'.!:!!i:,l';�li6i;::.:!,-,:.hl:;'.:1;6.jl:�ri..i -1J.i�6a`c..i�i:1::.a;i.,i...r`: <br /> RETURN TO COMPLIANCE,CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within $0 days,of <br /> receipt of this Inspection. This certification form must be submitted to the Environmental Health Department(EHL))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 25185(c)(3) <br /> Note: All EHD staff time associated with falling 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 dpcumenting what corrective actions were taken or will bs 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: July 19, 2021 Inspected By: CAROL PRESTO <br /> Facility Address: 3940 N TRACY BLVD, TRACY CI;RS ID: 10182335 <br /> 1 certify under penalty of law that: <br /> 1. •1 have correoted.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 a mCk_,p, , <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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: ,, ,�Q„, � Title: CA.-3 v4�/2_ .i, <br /> Signature: '�b faof i tiit>6'~ 1L ;A-C Date: <br /> AUG 18 2021 <br /> F-0\/Il0.)NMEiJTAL III Al 1 H <br /> PERMIT/SERVICES <br /> Received Time Aug, 18, 2021 4: 16PM No, 6869 <br />