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S A N ! O A Q U I N Environmental Health Department RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of receipt of this inspection . This certification form must be submitted to the Environmental Health Department (EHD) address at the bottom of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 1 . 2(c) ( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report, HSC 25185(c)(3) Note : All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete , the operator of the site must include: A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections Operator's certification Inspection Date : February 03 , 2020 Inspected By : SHEWIT WOLDEAREGAY Facility Address : 1126 E PINE ST , LODI CERS ID : 10181397 I certify under penalty of law that: 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true , accurate, and complete: Photos Paperwork Statement 3 . 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or imprisonment for known violations. (HSC 25191 ) daiL Name : hC1 Title : ( Signature : Date : 6�