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Environmental Health Department j <br /> i <br /> I <br /> t p <br /> RETURN TO COMPLIANCE CERTIFICATION ` <br /> G <br /> a <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 I <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 /> it <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. w <br /> f , <br /> it <br /> For this certification to be complete, the operator of the site must include: i !, <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 /> Operator's certification 1 <br /> Inspection Date: December 13, 2018 Inspected By: CLAUDIA MURO L. <br /> I , <br /> Facility Address: 1 WINEMASTERS WAY, LODI CERS ID: 10183687 k <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. " <br /> 3 <br /> I <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 /> t'-­Photos �aperwork Statement f <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> s <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) I+ <br /> Name: aj2M+-"I0.,25 !�s✓lk(r�2 <br /> Signature: �Lv Date: <br /> f( <br /> � i. <br /> i+ <br /> k <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 I F 209 464-0138 I wwwsjcehd.com <br /> II <br />