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Received 1/30/2022 <br /> SAN J O A Q I N Envie-ion Cental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any M1NOty violations noted in She"Notire 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 botiorn of this form within 30 days of receipt of the Inspection Report. HSC 25404.1,2(c)(1) <br /> All rwrecttons to other violations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> violalizns, 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 EHC staff time associated with Failing to comply by the above noted dates will be billed <br /> at the current hourly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement ditlWmentinu what corrective actions were taken or will be taken for each violation <br /> copies of sample rosulls/manifestsliraining records/other appropriate paperwork.and/or photos verifying correctlops <br /> Operator's certification <br /> Inspection Date: January 05. 2022 inspected 6y: KRISTINA SAETERN <br /> r, acility Address: 341 E C,WN ST, RIPON CERS ID: 101$1381 <br /> 1 certify under penalty of law that: <br /> have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> (2. have personally examined the following diacu.mentation submitted as proof of compliance FOR EACH VIOLATION <br /> and f believe the information to he true,accurate, and complete. <br /> Photos Paperwork Sialement <br /> I I am authorized to submit this certification on behalf of the Respondent. <br /> 4. !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 25.191) <br /> Name: I3 A- C--c L-� TilEe: <br /> Signature: Date: �L �� <br />