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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue , Stockton , California 95205 -6232 <br /> Telephone: (209 ) 468-3420 Fax: (209) 468- 3433 Web: www . sjgoy. or /c /ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply " in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection . This certification form must be submitted to the <br /> Environmental Health Department ( EHD ) address at the top of this form within 30 days of receipt of the <br /> 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 <br /> disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the 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 <br /> verifying corrections <br /> • Operator' s certification <br /> Inspection Date : May 22 , 2019 Inspected By : Zuna Barker <br /> Facility Address : 2448 Kettleman Ln . Lodi EPA ID# : <br /> I certify under penalty of law that : <br /> 1 . 1 have corrected the violations specified in the Inspection Report from the above- mentioned <br /> inspection date . <br /> 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true , accurate , and complete : <br /> Photos 'Paperwork=,c" ' Statement <br /> 3 . 1 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 <br /> possibility of a fine and/or imprisonment for known violations . ( HSC 25191 ) <br /> Name : �� i : � <br /> Title ' <br /> c- U . jer � _ a. <br /> Signature : Date : <br /> z <br /> EHD 22-02-005 Rev 04/19/12 <br />