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404 UIN <br />Environmental Health Department <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MI OR 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 #o other violations noted in the aftached Inspection Report (IR) or Contihuation 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 <br />billed at the current hourly rate. <br />t7r th15 CG'1'�IfICatlOn O b@ COt111J�8tG'I the operator of the site must include: <br />• A statement documenting what corrective actions were taken or will betaken 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 15, 2020 Inspected By: CAROL PRESTO <br />I=acilityAddress: 900 S CHEROKEE LN, LODI CERS ID: 10180627 <br />I certify under penalty of law that: <br />1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br />2. I have personally examined the following documentation submitt <br />ed as proof of compliance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete: <br />_,Photos Paperwork we <br />Sfatement <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 possibility of a fine <br />and/or imprisonment for known violations. (HSC 25191) <br />Signature: / � � Date: (&21 Wh 01 <br />v`/ I <br />