Laserfiche WebLink
12/12/2017 3:49 Pill FAX 2093394287 FLYNG J LODI CA 100006/0008 <br /> SAN MA Ou'N Environmen al,Health Department <br /> RETURN TO COMPLIAINCE CERTIFICATION <br /> Any M OR violations noted in the"Nodce to Comply"in the attached Inspection Report must be—colra-Medy&j1hin 30 days of <br /> receipt of this inspection. This XrtfCaton form must be submitted to the Environmental Health Department(EHD)address <br /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1,2(c)(1) <br /> All corrertinnei to of er viol tions noted In the attached Inspection Report(IR)or Continuation Form, v disputes to any <br /> violations, are to be submitted(sing this certification and returned to EHD yyithin 30 days unless othalwise specified in the <br /> InspectJon Report HSC 25185-c)(3) <br /> Note: All EHD staff time associated with failing to cor#ily by the above noted di tes will be <br /> billed at the curre'1t hourly rate. <br /> For this certification to be complete, the operator of the site must include: <br /> A statement documenting what Corrective actions were tekeipr will be taken for each vlolati <br /> on <br /> Copies of sample resu lstmanifestsAralning records/other appropriate paperwork, and/or pric Ws verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: Dec amber 07, 2017 Inspected Ely: ARON HANG <br /> Facility Address: 152 l7 N Thornton Rd, Lodi CEF5 ID: 10184349 <br /> I certify under penalty of law thin: <br /> 1, 1 have corrected the violations specified in the Inspection Report from the above-mentioned i spectIon date. <br /> 2. 1 have personally exan lined the following documentation submitted as proof of complience F OR EACH VIOLATION <br /> and I believe the Inforrr ation to be true,accurate,and compt to: <br /> Photos—X� aperwork Statement <br /> 3. 1 am authorized to sub nit this certification on behalf of the.Respondent, <br /> 4, 1 am aware that there;,re significant penalties for submitting,false information, including the aslbility of a fine <br /> and/or imprisonment fo known violations. (HSC 25191) tr <br /> Name: So e e—or, Title: C) .Ajdr ,�, j�c <br /> Signature: te' / -L <br /> 1868 E.Hazelton A.,enue Stockton,California 95205 1 T 209 468-3420 I F 209 464-0138 1 www.sicehd.coni <br />