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0 <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209) 468-3433 Web:www s' oy ordlehd_ <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any Ml violations noted in the"Notice to Comply" in the attached InspEnv'�onm nt I Health eport must eDepartment(EHD) address; <br /> receipt of this inspection. This certification form must be submitted to the <br /> E <br /> the top of this form within 30 days of receipt of the Inspection Re ort. HSC 25404.1.2(c)(1) <br /> or disputes to any <br /> All corrections to other violations noted <br /> in the attached Inspectio FR)ootia the <br /> violations, are to be submitted using this certification and returned to EHD W21 hin 30 dans unless otherwise specified in <br /> Inspection Report. HSC 25185(c)(3) NOV tf t017 <br /> Note: All EHD staff time associated with fail irt <br /> g gTRNp pr ggrf poted dates will be <br /> billed at the current hourly rate. DEPARTMENT <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 recordslother appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: June 27 2017 Inspected By: GARRETT BACKUS <br /> CELS <br /> Facility Address: 351 N BECKMAN RD, LODI OWID: <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.o compliance FOR EACH VIOLATION <br /> I believe the information to be true, accurate, and complete: n <br /> Photos _Paperwork Staterrie ,. <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 afse information,`inciuding the- of a fine and/ <br /> imprisonment for known violations. (H C 25191 <br /> NameG1 2 r Title: <br /> Signature:, <br /> �n <br />