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SAN , JOAQ, U IN EnvironmentalHealth Department RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the " Notice to Comply " in the attached Inspection Report must be corrected within 30 days of receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD ) address at the bottom of this form within 30 days of receipt of the Inspection Report . HSC 25404 . 1 . 2 ( c ) ( 1 ) All corrections to other violations noted in the attached Inspection Report ( IR ) or Continuation Form , or disputes to any violations , are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report . HSC 25185 ( c ) ( 3 ) Note : All EHD staff time associated with failing to comply by the above noted dates will be billed at the current hourly rate . For this certification to be complete , the operator of the site must include • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/ manifests /training records / other appropriate paperwork , and / or photos verifying corrections Operator ' s certification Inspection Date : October 21 , 2020 Inspected By : ELIANNA I LOi' IDQ Facility Address : 2449 W Kettleman Ln , Lodi CERS ID : 10156529 I certify under penalty of law that : 1 . I have corrected the violations specified in the Inspection Report from the above - mentioned inspection date . 2 . I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true , accurate , and complete : _ Photos _ Paperwork Statement 3 . I am authorized to submit this certification on behalf of the Respondent . 4 . I am aware that there are significant penalties for submitting false information , including the possibility of a fine and / or imprisonment for known violations . ( HSC 25191 )