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Received <br /> 9/26/2023 <br /> EnvironmentalHealth Department <br /> SAN JOAQUIN <br /> r.—I I 1N 'T '�j o <br /> RETURN TO COMPLIANCE CERTIFICATION <br />� Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected within 30 da s of <br /> receipt of this inspection, This certifcation form must be submitted to the Environmental Health Department (EFID) 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 EHE within 30 unless otherwise specified in the <br /> Inspection Report. HSC 25185(c)(3) <br />� Note : All EHE] staff time associated with failing to comply by the above noted dates will be ..billed <br /> at the current hourly rats. <br /> O <br /> M I <br /> far th is certif� cation 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 recordslother appropriate paperwork, andlar photos verifying corrections <br /> - operator's certification <br />--�� Inspection Date : April24 , 2023 inspected By : GABRIELA GARCIA-MEJIA <br />� Facility Address : 18806 N LOWER SACRAMENTO RD , WOODB CERS ID : 10181237 <br /> certify under penalty of law that: <br /> 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . <br /> 2 . f have personally examined the following documentation submitted as Graaf of compliance FOR EACH VIOLATION <br /> and ! believe the information to be true, accurate, and complete. <br /> Photos Paperwork Statement <br /> 3, i am authorized to submit this certification on behalf of the Respondent. <br /> i <br /> 4 . 1 am aware that (here are significant penalties for submitting false information , including the passibility of a fine � <br /> and/or imp isanment for known violations . (HSC 25191 ) <br /> Name � rA � 1 � � � Title: <br /> . i` <br /> Signaturg.- Date : <br />