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Ju1. 28. 2015 2: 22PM No- 2683 P. 1 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.orq/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be 4QERwAed within 30 day§of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <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 within 30 days unless otherwise sp�ifegairrt <br /> Inspection Report. HSC 25185(c)(3) VI FL,�.� ) <br /> Note: All EHD staff time associated with failing to comply by the aboe not atesZjl be <br /> billed at the current hourly rate. JUL 2 $ q <br /> For this certification to be complete, the operatorof the site must include:r(jVIRONMFNW <br /> A statement documenting what corrective actions were taken or will betaken for each violatlorf'T <br /> Copies of sample results/manifesta/training recordslother appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: June 29, 2015 . Inspected By: ARIS VELOSO <br /> Facility Address: 816 BLACK DIAMOND WAY, 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 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 25191) <br /> Name:I^c ♦ C—t c r�. Title: y <br /> Signature: Date: S <br /> N,71 <br /> "t'Of 0.,� KKZ nY o�OJS lA�s'�'t- N-�t�S�- yYlgvu F't$•{-5 <br /> I'/e��itr 4✓bib.nCS ` has ISIIc✓i�Cti.o/ 5trv' o >; <br /> CpvvlPHv�v� .rvr QJV L)tN,Ct � T'k. j i5 Oil ' <br /> Yhn;w\�p�;/h !'cco✓d5 �r � t�rwtair.tn� DSS Car 3 Y P_cY'S bu-6 040017 <br />