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San Joaquin County '�" <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton. California 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www siaov oro/ehd <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 <br /> the top 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 <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 resuttslmaniteststtraining recordslother appropriate paperwork. and/or photos verifying corrections <br /> Inspection Date: June 19, 2015 Inspected By: ARTS VELOSO <br /> Facility Address: 900 V2 E Victor Rd Lodi EPA ID: <br /> I certity under penalty of law that <br /> 1 1 have corrected the violations specified in the Inspection Report from the above-mentoned inspection date <br /> 2 1 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�aperwork (/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 and/ <br /> imprisonment for known violations. (HSC 25191) <br /> Name. 4;', t c Idle: <br /> G Fo <br /> Signatur Date: <br />