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S A N i 0 A O U I N Environmental Health DepartmoM <br />CCUNTv <br />JUL 12 2018 <br />RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL <br />HEALTH nFPARTMENT <br />Any MINOR violations noted in the "Notice to Comply' in the attached Inspection Report must be cweded wtMtin 30 dans of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address <br />at the top of this form within 30 days of receipt of the Inspection Report- 1-15025404-1.2(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 unless otherwise specified in the <br />Inspection Report. MSC 25185(c)(3) <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <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 recordsfother appropriate paperwork, and/or photos verifying <br />corrections <br />Operators certification <br />Inspection Date: <br />Facility Address: <br />July 05, 2018 Inspected By: JAMIE LIMA <br />6120 W BANNER ST, LODI <br />I certify under penalty of law that: <br />CERS 1D: 10185225 <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 K Paperwork 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 />Narne, A) L(1 (7 Title: k X <br />Signature`, ._—pate: <br />1868 E- Hazelton Avenue I Stockton, Gallfornia 952051 T 209 468-3420 I F 209 4640138 1 wvw.sicohd.com <br />