Laserfiche WebLink
SKJOAQUIN Environmental Health Department <br /> C0L ) NI Y <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 /> jNote : 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 21 , 2020 Inspected By : ELIANNA FLORIDO <br /> Facility Address : 2449 W Kettleman Ln , Lodi CER5 ID : 10156529 <br /> 1 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 ! tement <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 . ( NSC 25191 ) <br /> Name : b Title : E_07 <br /> 4110I '? +* L 4 <br /> Signature : Date . 1,9 - 2, 2 - - z0 . <br />