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SAN JOAQUIN _UIJN I l' Environmental Health Department RETURN TO COMPLIANCE CERTIFICATION AnyMINOR- i of ton noted its the "Notice to Comply 71 in the attached Inspection Report mut be. corrected within 30 days of receipt of this inspection. This certification fora must be submitted to the Environmental Health Department (EHID) address at the botlom of this form within 30 days of receipt of the Inspection f eport. HSC 25404-1,2(c)(1) All corrections to other violations acted in the attached Inspection Report (11 ) of Continu tion Form, or disputes to ars} violations, are to be submitted using thiscertification and returned to EHD within o days unless otherw' poi ed � t� Inspection Report, HSC25185(c)(3) Nate: A11 EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete, the operator of the site must include: statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paper orl ., rid/or photos verifying corrections Operator's certification Inspection Date: Marsh Q 1, 2023 Facility Address: 18662 N HWY 88, LOCKEFORD I certify under penalty of law that: Inspected By: GABRIELA GARCIA-MEJIA CERS ID: 10182137 1, 1 have corrected the viola tions specifled in the Inspection Report from the above-mentioned inspection d ate. . 1 have personally examined the following documentation submitted as proof ofo liance FOR EACH VI o L TI o and I believe the information to be true, accurate, and complete: Photos I an) authorized to submit this certification on behalf of the Respondent. Statement I ars aware that there are significant penalties for submitting false information, in chiding the possibility of a fine and/or imprisonment for known violations. (HSC 25191) L i Name-. Title: Signature: Date: