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2019 - 11 - 05 10 : 09 Sunwest Chevron 2758 > > P 1 / 1 <br /> SAN <br /> 7 Environmental Health Department <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 billed <br /> 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 Date : October 16 , 2019 inspected Sy : PAUL NSU <br /> Facility Address : 2758 W Kettleman Ln , Lodi CERS ID : 10748068 <br /> 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 submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete : <br /> Photos Paperwork Statement <br /> 3 , t 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/or imprisonment for known violations . (HSC 25191 ) <br /> ~� <br /> Name , d I 3 �-" Title: <br /> Signature: Dater AWRE <br /> G <br /> - WED <br /> lit <br /> ENVIRONMENTAL H ALTs i <br /> DEPARTMENT <br />