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received on 06/15/2023pn. <br /> SAN JOAN N Environmental Health Department <br /> C CtlJ FI-Y <br /> Greotnesc <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> AnyIM NOR violations noted in the"Nonce to Comply"in the attached Inspection Report must be correcte with" 30 s of <br /> receipt of this inspection.This certification form must be submitted to the Environmental Health[)apartment(EHO)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 EHC within 30 da+Ls unless otherwise specified in the <br /> Inspection Repod. HSC 25185(c)(3) <br /> Note: All END staff time associated with failing to comply by the above noted dates will be <br /> billed 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 resultslmanifestsftraining mcordslother appropriate paperwork,andlor photos verifying corrections <br /> Operators certification <br /> Inspection Date: June 01,2023 Inspected By: PAUL li <br /> Facility Address: 255 E Harney Ln,Lodi CERS IDS 10484500 <br /> i codify under penalty of law that <br /> 1. I have connected the violations specified in the inspection Report from the above-mentioned inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH.VIOLATION <br /> and I believe the Information to he true,accurate,and complete: <br /> Photos Paperwork // Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false infonnalion,including the possibility of a fine <br /> ariftr imprisonment fat known violations. (HSC 25191) <br /> Name: rP P G.aa'S Title:_ <br /> Signature: l'V���G� `^"" -r Date: <br />