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2019 - 10 - 23 09 : 12 Sunwest Chevron 2758 > > 2094683433 P 1 / 1 <br /> Environmental Health Department <br /> ' LS 1 ' EF <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 at <br /> the bottom of this form within 30 days of receipt of the Inspection Report , HSC 25404 . 1 .2(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 results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Rate : October 16 , 2019 Inspected By; SHEWIT WOLDEAREOAY <br /> Facility Address : 2758 W Kettleman Ln , Lodi CERS Ws 1074806 $ <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 . I have personalty examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and <br /> 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 . I am aware that there are significant penalties for submitting false information , including the possibility of a fine and/or <br /> imprisonment for known violations, (HSC 25191 ) <br /> Name: C� J �. . Title : <br /> Signature : Date : <br /> 1868 E , Hazelton Avenue l Stockton, California 952051 r 209 4W34201 F 209b s;jcehd c om " <br /> 1 ARIi EN <br />