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i <br /> y, � N Enviiroc� r� ea� tal Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION I <br /> Any MINOR violations noted in the " Notice to Comply ' in the attached Inspection Report must be corrected within 30 days of <br /> lk <br /> r:. <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department (EHD) address at <br /> the bottom of this form within 30 days of receipt of the Inspection Report. HSC 25404 . 1 . 2(c)( 1 ) a <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 EHD within 30 days unless otherwise specified in the <br /> Inspection Report , HSC 25185 (c)(3) <br /> i <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 results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date : July 05 2019 Inspected By : CLAUDIA MURO <br /> Facility Address : 820 S SACRAMENTO ST , LODI CERS ID : 10181443 <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 XPaperwork XStatement <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 possibility of a fine <br /> and/or imprisonment for known violations . ( HSC 25191 ) <br /> Name : Gwen Krenecki Title : Director <br /> Signature : Date : 7-18-19 <br /> RECE IV L <br /> JUL � 2019 <br /> ENVIRONMENTAL HEAT I <br /> DE.PAPITMENT <br /> I <br /> 1868 E . Hazelton Avenue 1 Stockton , California 95205 T 209 468-3420 1 F 209 464-0138 www. sjcehd . com <br />