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San Joaquin County <br /> Environmental Health Department <br /> 600 East Main Street, Stockton, CA. 95202-3029 <br /> Telephon : (209) 468-3420 Fax: (209) 468-3433 Web:www.sigov.org/ehd 08 Zpl, <br /> RETURN TO COMPLIANCE CERTIFICATION MC.,T <br /> Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected <br /> within 30 days of receipt oft is inspection. This certification form must be submitted to the Environmental <br /> Health Department (EHD) ad ress at the top of this form within 30 days of receipt of the Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and return to EHD within 30 days unless <br /> otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the <br /> current hourly rate. <br /> For this certification to be omplete the operator of the site must include: <br /> o A statement d cumenting what corrective actions were taken or will be taken for each violation <br /> o Copies of sam le results/manifests/training records/other appropriate paperwork, and /or photos <br /> verifying corrections <br /> o Operator's ce ification <br /> Inspection Date: June 30, 2011 Inspected By: Mike Lewis <br /> Facility Address: 1210 S. Cherokee Lane, Lodi, CA 95240 EPA ID# CAD054598289 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected tt e violations specified in the Inspection Report from the above-mentioned <br /> inspection date <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> X Photos X Paperwork X 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Mike Lewis Title: Service Manager <br /> Signature Date: 06/30/2011 <br />