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{JOAQUIN Environmental Health DepartmentSAN i <br /> Ott N T Y <br /> fir ; tr, <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted In the `Notice to Comply" in the attached Inspection Report must be coirected 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 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 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 : April 14 , 2022 Inspected By : CAROL PRESTO <br /> Facility Address , 24572 S MACARTHUR , TRACY CERS ID : 10187493 <br /> certify under penalty of law that: <br /> 1 . 1 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 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> andlor imprisonment for known violations . (HSC 25191 ) <br /> Name : tic _Title :, 6 <br /> Signature : Date : yDI veL I2 <br /> RECEIVE ® <br /> c , A �; 12 2022 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />