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Environmenrtal Health artment <br />{'- il i .l i'.i'l ''t' <br />iri, I ,. r :' <br />RETURN TO COMPLIANCE CERTIFIGATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be !:ofrected withln 3 <br />receipt of this inspection. This certification form must be submitted to the Environmental Health D'epartment (iEHD) <br />the bottom of this form within 1]0 days of receipt of the Inspection Report. HSC 25404.1'2(CX1) <br />All corrections to other violations noted in the attached Inspection Report (lR) or Continualion Form, or disputes to any <br />violations, are to be suomitted using this certification and returned to EHD within 30 davs unless otherwise slrecified in <br />Inspection Report. HSC 25185(c)(3) <br />Note: All EHD staff time associated with failing to comply by the above noted dates urill be <br />at the current ho,urly rate. <br />For this certification tO be Complete, t'"operatorof thesitemustincfude: <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 paperworkl and/or photos verifying <br />Ooerator's certifi cation <br />f nspection Date: MaY 04' 2022 Inspecfed By':JOHN <br />Facility Address:2{'651 N HWY 99, ACAMPO CERS lD: 10181469 <br />of <br />ot <br />I certify under PenaltY of law that: <br />.1 . lhave corrected the violations specified in the Inspection Reportfrom the abov{-mentioned inspet;tion date' <br />2. I have personally clxamined the following documentation submitted as proof of compliance FOR E:ACH VIOL <br />and I believe the information to be true, accurate, and complete: <br />I am arrthorized to submit this certification on behalf of the Respondent' <br />I am aware that there are significant penalties for submitting false information,the possibilitY of a <br />violations. (HSC 25191) <br />DP1 H6tr Title: <br />t-7 / ?DLL