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SHAWN Environmental Health Department <br /> el h <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> ♦fir WNW violleions noted in the'Notice to comply"in the attached Inspection Report must be corrected within 30 days of <br /> 'ircerpl of ties radion Ties certification form must be submitted to the Environmental Health Department(EHD)address at <br /> -*'--Own of tilts berm vAlthit 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br /> All :�,^eKeorss to after v+elations noted in the attached Inspection Report(IR)or Continuation Form,or disputes to any <br /> vK+.—tem are to be submilt1ed using this oertibCabon and returned to EHD within 30 days unless otherwise specified in the <br /> Ir an Report H ISC 25185(c)(3) <br /> Note: All EKD 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 siaten - ;_•__­enlung what corrective actions were taken or will betaken for each violation <br /> Copes of sa-=- -esu's'rnanifesWtraining records/other appropriate paperwork,and/or photos verifying corrections <br /> Operabor s ce-L=a-_- <br /> irts;xc&m Date: February 15, 2022 Inspected By: CAROL PRESTO <br /> F Arty Address: 25775 S PATTERSON PASS RD,TRACY CERS ID: 10181249 <br /> 1 Oif under pw ally of tarp that_ <br /> 1 1(save ownxted the viotabons specified In the Inspection Report from the above-mentioned Inspection date. <br /> 2 1 hove persona i examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and 1 Isetrave the information to be true,accurate,and complete. <br /> Photos Paperwork Statement <br /> 3, 1 am suilihorkzsd to submit this cer0cstion on behalf of the Respondent. <br /> 4, 1 am warts OW two an a+gnrlHralrrl penalties for submiHing false Information,Including the possil lllb of a Mia <br /> arW*krpWartinwil for krwwn vlolatlons. (HGC 2519 1) <br /> No,, �N ��i E�— .,Title:, V4,nc, -;-c <br /> r Dole: Z-, <br />