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SAN JOAQU IN Environmental Health Department <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 certification farm must be submitted to the Environmental Health Department (EHD) address at <br /> the bottom of this farm within 30 days of receipt of the Inspection Report. H5C 25404. 1 , 2(c)( 1 ) <br /> All corrections to other isolations 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 3� da s unless otherwise specified in the <br /> Inspection Report. HSC 251 $5(c)[3) ! <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be dw <br /> a <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 recordslother appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : April 30 , 2025 Inspected By: MARIA LOPEZ <br /> Facility Address : 1 $806 N LOWER SACRAMENT4 RD , VVODDB CERS Id: 10181237 <br /> 1 certrty under penalty of law that � <br /> 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> x 2 I 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 /> PnotasPaperwork Statement ' <br /> 3 . I am authorized to submit this certification an behalf at the Respondent <br /> r <br /> 4 . 1 am aware that (here are significant penalties for submitting false information, including the possibility of a fine and/or <br /> imprisonment for known violations. (H9C 25191 ) <br /> Name : 1Y—Y-Cj !'1r1 ���L�kuv Title : r <br /> �� <br />� Signature : Date : <br /> Oro <br /> rr ra � 1 ■ I�R����f�A� <br />