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I <br /> San Joaquin County <br /> Environmental Health Department <br /> 1868 Eat Hazelton Avenue, Stockton, California95205-6232 <br /> Telephone: (2 9)468-3420 Fax:(209)468-3433 Wet:www.sigov oro/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations nOtE d in the"Noti6e to Comply" in the attached Inspectioti Report must be corrected within 30 days of <br /> receipt of this inspection. his certification form must be submitted to the Enver nmental Health Department(EHD) address <br /> the top of this form within 2 0 days of recgipt of the Inspection Report. HSC 254 4.1.2(c)(1) <br /> All corrections to other viol ations noted in the attached Inspection Report(IR) or Continuation Form, or disputes to any <br /> violations, are to be submitted using this1certification and returned to EHD withir 30 days unless otherwise specified in the <br /> Inspection Report_ HSC 2 185(c)(3) <br /> Note: All EHD staff time associated with failing to comply by the above n <br /> billed at the current hourily rate. oted dates well be <br /> For this certificate n to be 1complete, the operator of the sit must include: <br /> A statement docum nting what coQrrective actions were taken or will bet ken for each violation <br /> Copies of sampler sults/manife is/training records/other appropriate pa erwork, and/or photos verifying corrections <br /> Inspection Date: Se tember 17, 2018 <br /> Inspected By: STACY RIVERA <br /> Facility Address: 20 W TURNER RD, LODI <br /> CERS ID: 10180633 <br /> I 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 a amined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the informa ion to be true, accurate, and complete: <br /> Photos Paperwork atement <br /> 3. 1 am authorized to submit this cerlification 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 and/ <br /> imprisonment for known violations. (HSC 25191) <br /> LNarne.- <br /> Title <br /> : <br /> Signature: P -- Date: <br />