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RECEIVED <br /> San Joaquin County APR 2 217 <br /> Environnenial Health Department <br /> 1858 East Hazelton Avenue,Stockton.Calikxnia 95205.6232 <br /> Telepfrone:(209)468-34420FW(209)46&3433wet,: o,,. /eh FNVIRONMENt <br /> -. ,HEALTH <br /> RETURN TO COMPLIANCE CERTIFICATION DFP,AF T <br /> Any MINOR violations noted in the"Notice to Comply'in the attached krpecbon Report must be 'hin 3O da of <br /> receipt of this inspection. This certification form must be submitied to the Environmental Health Department(EHD)address at <br /> the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.12(cx1) <br /> ApcorreOtions to other vblatiorts 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 wi )n 3o days unless Otherwise specified in the <br /> Inspection Report HSC 25185(c)(3) <br /> Note: All EHD staff time associated with tailing 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 statemerrt documenting what corrective actions were taken or will be taken for each violation <br /> Copies Of sample results/mandestsytraining recoMstother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: _March 30,2017 Inspected By: AARON HANG <br /> Facility Address: 14971 N HWY 88, LODI EPA ID: <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 /> 2. 1 have personalty examined the follOwirg documentation submitted as p700 <br /> compliance FOR EACH VIOLATION and <br /> I believe the irdomration m be true,acarrate,and complete: <br /> Photos Paperwork Statement <br /> 3. t am authorized to submit this certification on behalf of the Respondent <br /> 4- 1 am aware that there are significant penalties for subrniuing false information,including the possibility of a fine and/or <br /> impnsonnpa or(mown violations. (HSC 25191) <br /> (/ ( Son ( r <br /> Name: Vh Title: '� W*�c� <br /> Signature: AP Date: W <br /> Zoo/ Zo0'd BZ60tl tegllt££60Z ot:ZT LLOZ/S211r0 <br />