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San Joaquin County RECEIVED <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 SEP 2 2 2016 <br /> Telep one:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.orq/ehd <br /> RETURN TO COMPLIANCE CERTIF,CkhbVIIIENTAL HEALTHEPARTMENT <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 <br /> the top 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 ising this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 2518 (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 certificatior to be complete, the operator of the site must include: <br /> A statement document ng what corrective actions were taken or will be taken for each violation <br /> Copies of sample resu ts/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Inspection Date: Au u t 18, 2016 Inspected By: ARIS VELOSO <br /> Facility Address: 1551 EIGHT MILE RD, LODI EPA ID: <br /> I certify under penalty of law th t: <br /> 1. 1 have corrected the vic lations 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 /> I believe the informatio to be true, accurate, and complete: / <br /> Photos X Paperwork ?y Statement <br /> 3. 1 am authorized to sub it this certification on behalf of the Respondent. <br /> 4. 1 am aware that there ire significant penalties for submitting false information, including the possibility of a fine and/ <br /> imprisonment for know i violations. (HSC 25191) <br /> Name: /} �L ,�%NC: //E",°Ty Title: Jh�O S6401g,X 1//50r4e <br /> Signature: -----Date: <br />