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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.sjgov.org/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 davs 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. 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 results/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Inspection Date: October 15, 2014 Inspected By: ARIS VELOSO <br /> Facility Address: 1331 S Ham Ln, LODI EPA ID: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-tnentioned 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 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 /> Name:, *!Icy Title: f 9v,etrV" <br /> Signature: Date: i i <br /> x '{03 a:ll vvr ski Syr iM/ rdOQ_;_ 6� Scoll-p L4,'-- '01 <br /> ^S � ) )co d� £ /1,a,� anD W:<< i ,✓� f)( Sr,rf1 u31111 J>rL.r 5 <br /> US�E�v "t,1r�Cerk"rf �cb <br /> W, �� be Skry fhr UPJ Catilo„w. <br /> 77'W T l�t(Cf l I•i i�jj2LV <br /> �1g1I'r5'r t,l: t� Vv ��-�(d£ YD d�rs J✓ra � y�yr <br />