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Environmental Health Department <br /> N OAQ IN <br /> = t "' °- ­ Received by the SJCEHD (CM) on 01/11/19 <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be corrected within 30 days 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 recelpt'of the Inspection Report: HSC 25404.1.2(c)(1) E <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 i <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 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 i <br /> corrections r <br /> Operator's certification <br /> i <br /> Inspection bate: December 13, 2018 inspected By: CLAUDIA MURO <br /> Facility Address: 1 WINEMASTERS WAY, LODI CERS ID: 10183687 <br /> certify under penalty of taw that: <br /> i <br /> I <br /> 1. 1 have corrected the violations specified In the inspection Report from the above-mentioned inspection date. s` <br /> i <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 'r-�Paperwork Statement <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 foreknown violations. (HSC 25191) <br /> ' <br /> Name: .t B 1 4ZELAt/D Title: <br /> Signature: �� Date: <br /> r <br /> . i <br /> i <br /> i. <br /> i <br /> i <br /> i' <br /> i' <br /> F <br /> L <br /> 1868 E.Hazelton Avenue I Stockton,California 952051 T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br />