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SANAMUIN <br /> Environmental Health Department <br /> .. __....C O U N T Y.,.,—. <br /> a N' Gemofnw4s grows here, <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any AOR violations noted in the'Notice to Comply'in the attached inspection Report must be comed9d within 30 days of <br /> receipt of this ion. This cer ficaton form must be submitted to the Environmental Health Department(EHD)a <br /> at the top of this form within 30 days of mcW of the Inspection Report. HSC 25404.1.2(c)(1) <br /> Ah to other vitiate noted in the attached Inspection Report OR)or Continuation Form,or disputes to any <br /> violations,are to be submitted using this caffmation and returned to EHD within 30 days fabless otherwise specified in the <br /> Inspection Report HSC 25185(c)(3) <br /> Note: Ali EHD staff time associated with failing to comply by the above noted dates wilt be <br /> billed at the current hourly rate. <br /> Forthis certification to be Complete, the operator of the site must Include: <br /> A statement documenting what correctim actions were taken or will be tatcen for each vitiation <br /> Copies of sampie resultsRhta ' th9 mcords/ot er appropriate paperworK and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: June 22,2018 Inspected By: ZUNA BARKER <br /> Facility Address: 351 N BECKMAN RD,LODI CERS ID: 10181401 <br /> I car*under penalty of law that <br /> 1. I have corrected the violations specified In the inspection Report from the above4nentioned Inspection data. <br /> C- <br /> 2. 1 have personally ommined the fbilovAng documentation submitted as proof of compliance FOR EACH VIOLATION r <br /> 0 <br /> and I belleve the information to be true,accurate,and complete. <br /> photos� �_StatemeM <br /> z CD <br /> 3. 1 am authorized to submit the certification on behalf of the Respondent <br /> 4. 1 am aware that tiara are significant penalties for subrnittrg fad information,Including the possibility of a fine <br /> and/or Imprisonment for Imow n violations. SC 25191) <br /> r <br /> Name:�� Title: v <br /> S1gnatu • 2- _Date: <br /> I <br /> 1868 E Hazelton Avenue I Stoddoh,Cafifomia 95205 I T 209 466 34201 F 209 4640138 1 www.sicatid.com <br />