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San Joaquin County Environmental Health Department 1868 East Hazelton Avenue , Stockton , California 95205-6232 Telephone: (209) 468- 3420 Fax : (209) 468- 3433 Web : www. sjgov. org/ehd RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the " Notice to Comply' in the attached Inspection Report must be corrected within 30 days of receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD) address ; the top of this form within 30 days of receipt of the Inspection Report , HSC 25404 . 1 . 2 (c) ( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report , HSC 25185 (c) (3) Note : All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate. For this certification to be complete , the operator of the site must include : A statement documenting what corrective actions were taken or will be taken for each violation Copies of sample results/manifests/training records/other appropriate paperwork , and/or photos verifying corrections Inspection Date: March 28 , 2019 Inspected By : STACY RIVERA Facility Address : 1301 W KETTLEMAN LN , LODI CERS ID: 10180585 I certify under penalty of law that : 1 . 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date . 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION I believe the information to be true , accurate , and cofnplete : Photos rPaperwork Statement 3 . 1 am authorized to submit this certification on behalf of the Respondent . 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine and/ imprisonment ,for known violations . (H & 25191 ) Name : l \ tti C V/ � C C Title : '� I Signature: Date: 14 - " � �