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Received <br /> 1/25/2024 <br /> SAN J DAQ U I N Environmental Health Department <br /> r. COUNTY <br /> �iipOlnti;S 1)fOw'S fiErf. <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 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 failing to comply by the above noted dates will be billed <br /> 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 reoordslother appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: January 24, 2024 Inspected By: SHEWIT WOLDEAREGAY <br /> Facility Address: 3725 N TRACY BLVD, TRACY CERS ID: 10181411 <br /> 1 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 )4�' Paperwork X" 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 /> and/or imprisonment for known violations. (HSC 25191) <br /> � ! Title: 041'6Q �U7I%r//5A-cif/✓t° 6�r'/'c <br /> Name: �'I <br /> Signature: Date: <br />