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San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, Califomia95205-6232 <br />I; . 11 I'll, 7 L twt1111 I <br />&LILL L WAIAM&91111 <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 EHDwithin 30 days unless otherwise specified in the <br />Inspection Report. HSC 25185(c)(3) <br />Note: All EHD staff time associated With failing 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 of the site must include: <br />A statement documenting what corrective actions were taken or will be taken for each violation <br />Copies of sample resultstmanifests(training records(other appropriate paperwork, and/or photos verifying correctiow, <br />1 1-1 1-1 11 11 <br />Inspection Date: ZU'16 Inspected By: ARIS VE1_()S(1), <br />Facility Address: 40","! NPf KETTILEMIAN L -N LODI EPA Ia. <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 VIOLA <br />I believe the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine <br />imprisonment for known violations. (HSC 25191) <br />IM <br />Signature: Date: <br />