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OCT-27-2008 18:29 CITY OF LODI 209 333 6710 P.42 <br /> SAN JOAQUIN COUNTY <br /> vIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton.,CA 95202-3029 <br /> Telephone: (209)468-3420 Fox; (209)468-3433 Web:www.sigov.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOviolations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 daKs of receipt of this inspection, This certification form must be submitted to the <br /> Environmental Health Department(EHD) address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate ($98). <br /> For this certification t0 be completethe 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 <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: Ct�u4 06 Inspected Tay: A.0-0. uLCAP IT- <br /> .Facility Address: 433 ( S• qA m Ldn11'. EPA ID#: GAb !J$3ro-7 x.60 l <br /> Q'!✓W t Y r-r o0 6 0o 7-8 <br /> I certify under penalty of law that: <br /> I. I have corrected the violations specified in the inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> _Photos V/ Paperwork VacStatement <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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: 1It�is :�. C ask r civ aN Title: <br /> Signature: <-S�C_� ,----.— Date: Lo 2.- oS <br /> EHD 22-02-005 Rev 11/07 <br />