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Environmental Health Depart ent <br /> SANzoJOAQUIN <br /> � 7 a <br /> qrore5 here , <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notiva to CompIrin the attached inspection Report mush be corrected within 30_days of <br /> receipt of this inspection . This certification fans 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 /> ASI corrections to other violations noted in the attached Inspection Report (11R) or Continuation Form , or disputes to any <br /> violafions, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSS 25185(c)(3) <br /> Note : 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 th 'i's certl*fication to be complete , the operator of the site must include: <br /> • A statement documenting what collective actions were taken or will be taken for each violation <br /> • Copies of sample results/manifests/training recardslother appropriate paperwork, and/or photos verifying corrections <br /> • operator's certification <br /> Inspection Date : March 26 , 2024 Inspected By: KRISTINA SAETERN <br /> Facility Address : 2500 W Turner Rd , Lodi CERS [D: 10403278 <br /> certify under penally of law that <br /> 1 . I have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following docurnentaton submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate, and complete: .6 <br /> _,_,Photos Paperwork ... Statement <br /> 3. [ am authorized to submit this certification on behalf of the Respondent. <br /> 4 . I am aware that there are significant penalties for submitting false information , including the passibility of a fine <br /> and/or imprisonment for known violations. (HSC 25 'i } <br /> Name : Z>V- %,07 rTitle : <br /> or 0 00, <br /> Signature . - Date . <br /> Scanned with CamScanner <br />