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San Joaquin County IUL ® 8 2011 <br />Environmental Health Department'�RON <br />600 East Main Street, Stockton, CA. 95202-3029 PERn,�MENi'A. HEALTH <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sigov.org 94:_ RV10Ec <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be corrected <br />within 30 days of receipt of this inspection. This certification form must be submitted to the Environmental <br />Health Department (EHD) address 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 complete the operator of the site must include: <br />o A statement documenting what corrective actions were taken or will be taken for each violation <br />o Copies of sample results/manifests/training records/other appropriate paperwork, and /or photos <br />verifying corrections <br />o Operator's certification <br />Inspection Date: June 29, 2011 Inspected By: Mike Lewis <br />Facility Address: 1190 S Cherokee Lane, Lodi, Ca. 95240 EPA ID# CAL000337354 <br />I certify under penalty of law that: <br />1. 1 have corrected the 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 Lew" Title: Service Manager <br />Signature ��/� Date: 06/30/2011 <br />