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Dollar Tree Regional 2099825678 p,3 <br /> HEGE I <br /> San Joaquin County NOV 05 201 <br /> Envnonmental Health Department <br /> 1868 East Hazellon Avenue.Stockton,C8lifcrnia 95205,6232 ENVIR®NIthEN <br /> Telephone:(209)4683420 Fax:{209)468.3433 Web:www;jgov orofehd HFAITH nr:DARTM <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply°in the attached Inspectior.Report must be correoled within 30 dans of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> the top of Iles form within 30 days of receipt of the Inspection Report. HSC 2540412(c)(1) <br /> All conectrons to otha vi.g n,noted in the attached Inspection Report(IR)or Contiruation Form,or disputes to any <br /> viol86011s,are to be submitted using this certfficalion and returned to EHD wijhm30 days unless otherwise specified in the T <br /> Inspection Report, HSC 25185(c)p) <br /> t <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 /> MJ Copies of sample results/manilesfsllraining recordstother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date, October 06, 2015 Inspected By: JAMIE DE LA ROSA <br /> j� Facility Address: 450 S Cherokee Ln. Lodi EPA ID: C A LOX r{0- q 022, <br /> I certify under penalty of law that: <br /> 7 <br /> t. 1 have corrected the violations spedfied in the Inspection Report from the strove-mentioned inspection date. <br /> -r <br /> 2. /have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: <br /> Photos ✓ Paperwork ✓ Statement <br /> 3. lam authorized to submit this certification on behalf of the Respondent. <br /> 4 ram aware that there are significant penallies for submitting false information,including the possibility of a fine andic <br /> rmpWnmerttlorknoivnyia 0onS1 (HSC25191) <br /> Title,_ r t CA fry C�mpt j aj U <br /> f 3`19'lura ' . ` Date: 70 1 5 <br />