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J <br /> C A , JOAQUIN Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR vi lations ne ed in the"Notice to Goll in the attached Inspection Report must be correctec within 30 days of <br /> receipt of this inspection. This certification form .rr ust be submitted to the Environmental Health Department(EHD) address at <br /> the bottom of this form wi hin 30 days of receipt oi the Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections o other violations noted in the attached Inspection Report(IR) or Continuation Form,or disr lutes to any <br /> violations, are to be submitted using this certificate n and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 5185(c)(3) <br /> Note: All EHD staff time associate: with flailing 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 doc imenting what correctiVe actions were taken or will be taken for each violation <br /> Copie of sample results/manifests/trains g records/other appropriate paperwork, and/or photos VE rifying corrections <br /> Operator's certifi ation <br /> Inspection ate: September 16, 2020Inspects By: CAROL PRESTO <br /> Facility Address: 20 W TURNER R #A, LODI CERS ID: 10180633 <br /> I certify under penalty of aw that: <br /> 1. 1 havq corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personal y examined the followirill documentation submitted as proof of compliance FOR I ACH VIOLATION <br /> I <br /> and I elieve thf information to be true, E ccurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am luthorized to submit this certificati n on behalf of the Respondent. <br /> 4. 1 am Iware that there are significant pe sties for submitting false information, including the posse ility of a fine <br /> andlorimprison ient for known violation (HSC 25191) <br /> Name: C V/0119i Title: nJ7Y4;-� <br /> Signature: Date: <br />