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06/19/2018 12:58 2098585 66 TWOGUYS PAGE 01/01 <br /> " 0: Environmental Health Department <br /> U.:Nj-: ;;,,..�,r%a:. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any WINO violations noted in the"Notice to Comply'in the attached Inspection Report must be corrected within 30 dews of <br /> receipt of this inspection. This certification form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report, HSC 25404,1.2(c)(1) <br /> All ZjLei s t her vi ation 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 unless otherwise specked 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 state ment'documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifeets/training records/other appropriate paperwork,and/or photos verifying <br /> correotions <br /> Operator's certification <br /> Inspection Date: June 14, 2018 Inspected By: ZUNA BARKER <br /> Facility Address: 147 E LATHROP RD, LATHROP CERS I : 101814.21 <br /> 1 certify under penalty of law that: <br /> 1. I 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 F_ACH VIOLATION <br /> and I believe the information to be true,accurate,and complete: <br /> Photos Paperwork � Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. t 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; 66- 1 G/f Title: d},t/pq �� <br /> Signature- Date: <br /> D7 <br /> JUN 19 1 <br /> ENVIROWENTAL <br /> P <br /> 1388 E. Hazelton Avenue I Stockton,California 95205 i T 209 468-84201 F 209 464-0138 ) www.$)cehd.com <br /> Received Time Jun. 19. 2018 12 : 32PM No. 3737 <br />