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08/20/2015 15:15 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, California 952056232 <br />Telephone: (209) 4683420 Fax: (209) 466-343$ Web: www.sigov.or /g ehd <br />RETURN. TO COMPLIANCE CERTIFICATION <br />#2544 P. 001/007 <br />Any t�rtlNQR 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 />at the top of this form within 30 days of receipt of the Inspection Report MSC 25404.1.2(c)(1) <br />All?f_reCtions to other viola#ions 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 39J days unless otherwise specified in the <br />Inspection Report HSC 25155(0)(3) 1 <br />Note: All EHD staff time associated with failing to comply by tit® above noted dates will be <br />billed at the current hourly rate. 0 <br />For this certifcatiort to. be.complete, theoperator..ofthesitemustinclude: <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br />corrections <br />Inspection Date: July 31, 2018 T� Inspected By: ELIANNA FLORIDO <br />Facility Address: 1004 S CHEROKEE LN, LODI CERS ID: 0 <br />I certify underipenalty <br />of law that: <br />1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIdL <br />A710N <br />and I believe the information to be true, accurate, and complete; <br />Photos Paperwork—,—Statement <br />3. I am authorized to submit this certification on behalf of the Respondent <br />4. I am aware that there are significant penalties for submitting false information, including the possibility of a fi <br />ne <br />andlor imprisonment for known violations. (HSC 25191) <br />Signature: Date. <br />+Js �iVifri\1";"r\i. <br />