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RECEIVED <br /> JUN 0 7 2019 <br /> EMARO MENTAL HEALTH, <br /> DEPARTMENT <br /> SAo A � u ( � Environmental Health Department <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the %olive 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 forth within 30 days of receipt of the Inspection Report HSC 25404.12(c)(1 ) <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 /> 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 resultstmanifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: May 10 2019 Inspected By: CLAUDIA MURO <br /> Facility Address: 1310 THURMAN , LODI CERS ID: 10184241 <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 subrr ted as proof of oo fiance FOR EACH VIOLATION <br /> and I believe the Information to be We,c�lrate, and compl <br /> / Photos 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/orimprisonment for known violations. (HSC 25191) <br /> Name: � F` 2 � {C6Z_ Title: �!✓� (// Q'� <br /> Signature: Date! <br /> 1868 E. Hazelton Avenue 1 Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />