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SAf��f}�iiff� En� lronlr>�tental Health Department <br /> N! •�f l ! : <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIN solations noted in the "Notice to Comply' in the attached Inspection Report must be corrected witUin 50 days of <br /> receipt of inspection . This certification form must be submitted to the Environmental Health Department (EHD) address <br /> at the top his form within 30 days of receipt of the Inspection Report, HSC 25404 , 1 .2(0)(1 ) <br /> All correct s to other viol ions noted in the attached Inspection Report (IR ) or Continuation Form , or disputes to any <br /> violations , to be submitted using this certification and returned to EHD within 3o days unless otherwise specified in the <br /> Ihspectio port. HSC 25185(c)(3) <br /> Note : EHID staff time associated with failing to comply by the above noted dates will be <br /> ed at the current hourly rate. <br /> IFi <br /> i <br /> For thl certification to be complete , the operator of the site must include: <br /> atement documenting what corrective actions were taken orwill be taken for each violation <br /> les of sample results/manifests/training records/other appropriate paperwork, and/or photos ver" rig <br /> ections <br /> rator's certification <br /> { Inspect Date; May 003 201 Inspected By : CLAUDIA MURO <br /> Facility dress : 335 E KETTLEMAN LN , LODI CERS On 10187053 <br /> I certify u r penalty of law that: <br /> 1 , I ve corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2000 ve personally examined the following dooumentation submitted as proof of compliance FOR 1=ACH VIOLATION <br /> I believe the information to be true , accurate, and complete: <br /> Photos Paperwork Statement <br /> 1 I authorized to submit this certification on behalf of the Respondent, <br /> 41 t aware that there are significant penalties for submitting false Information, including the posslblllty of a fine <br /> a or imprisonment for known violations. (HSC 25191 ) <br /> Na Titie : <br /> ,Sip urea Garp • <br /> 1868 E , Hazelton Avenue ` Stockton, California 95205 1 T 209 .468-3420 { F 209 464-0138 1 www.sjcehd.com <br />