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Feb 20 2019 12:35PM Dave Robinson 209-751 -2157 page 1 <br /> � 4gel <br /> g ® <br /> San Joaquin County <br /> Environmental Health Department (L:. B 2 209 <br /> 1888 East Hazelton Avenue, Stockton , California 95205 -6232 <br /> Telephone: (209) 468-3420 Fax: (209) 488- 3433 Wob: www , s' ov ,or eh <br /> 'ENVIRONMENTAL HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATION IF) EPARTMENT <br /> AnyMINOR 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 at <br /> 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 1XIthin 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25165(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 recordslother appropriate paperwork , and/or photos verifying corrections <br /> Inspection Date : February 08 , 2017 Inspected By : JAMIE LIMA <br /> Facility Address : 351 N 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 and <br /> I believe the information to be true , accurate, and complete: <br /> A 1WV 0460 <br /> Photos Paperwork Statement <br /> 3 , 1 am authorized to submit this oertifioetion 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/or <br /> Imprisonment for known violations , ( HSC 26191 ) <br /> Narne :_ .Os>>_ i�?6a -f ten/ Title ; / T_Y f +I�� Qoww ra4 face <br /> Signature ; _ - � Date : "j <br />