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�, $ANJONOUIN <br /> -' k1 —COUNTY— <br /> v, Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Reportmust be corrected Within <br /> 30 days of receipt of this Inspection. This certification form must be submitted to the Environmental Health <br /> Department (EHD) address at the top of this form within 30 days of receipt of the Inspection Report. HSC <br /> 25404.1.2(c)(1). <br /> All corrections to otheoviolations noted in the attached Inspection Report (IR)or Continuation Form,or disputes to <br /> any violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise <br /> specified in the Inspection Report. HSC 25185(c)(3). <br /> Note: All EHD staff time associated with falling to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> Forthis certification tobe 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 <br /> verifying corrections. <br /> • Operator's certification. <br /> Inspection Date: March 14,2019 Inspected By: Cesar Ruvalcaba <br /> Facility Address: 927 E. Black Diamond Way, Lodi, CA 95240 CERS ID: 10181405 <br /> 1 certify under penally of law that: <br /> 1. r have corrected the violations specified in the Inspection Repoafrom the above-mentioned inspection data <br /> 2 I 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 X Paperwork X Statement <br /> a I am enhanced 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 /> andlor Imprisonment for known violations. (HSC25191) <br /> Name: Mark ,H��aa/ndel Title: Director of Safety and Compliance <br /> Signature: AJL Date: 20/9 <br />