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r <br /> Environmental Health Department <br /> SAN JOAQUIN <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> d within 3a sof <br /> d <br /> qny MINOR violations noted in the"Notice to <br /> Comply"in the attached Inspection Report must be ^,ra.r..�cta�-� <br /> receipt of this inspection.This aertilication form must be submitted to the Environmental Health Department(END)address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404.1,2(c)(1) <br /> All corrections Other viglai noted in the attached Inspection Report(IR)or Continuation Form,or dispules to any <br /> violations,are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> 10 <br /> Inspection Report, HSC 25185(c)(3) <br /> Note: All EHD staff time associated with falling 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 ofihe site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> - Copies of sample resulialmanifestshmining recordelother appropriate paperwork,and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: December 12,2019 Inspected By: CLAUDIA MURO <br /> Facility Address: 500 E KETTLEMAN LN,LODI CERS ID: 10183993 <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 <br /> and 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, l am aware khat there are significant penallies for submitting false information,including the possibility of a fine <br /> andfor imprisonment for known violations. (HSC 25191) <br /> Name: lk Title, f•1L4 <br /> 5ignature:`f _� y Dater-y_�2(l�p <br />