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I <br /> , <br /> s <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton,California 95205-6232 <br /> 7'elephorre:(20}468-3420 Fax:(209)468-3433 Web:w'wW _3c oy.orglehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected .ith 30 days of <br /> receipt of this inspection,. This certification form must be submitted to the Environmental Health Department(EHD)address o <br /> the top of this form within 30 days of recelpt.of the Inspection Report. HSC 25404.1.2(c)(1) <br /> All co[rections to other violations rioted 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 EHDit�hi .30 days unless otherwise specified lig the <br /> Inspection Report. HSC 26185(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 corrections <br /> Inspection Date: AElqust 10, 2015 Inspected By: ARTS VELOSO <br /> Facility Address: 1020 S BECKMAN RD, 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-mentioned 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 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 and! <br /> imprisonment for known violations: (HSC 26191) <br /> Name: hLvdg iJ Title: <br /> Signature: �� _ Date: <br /> RECEIVE[.), <br /> SEP 0 9 2015 <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />