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54ru JfiAilL}Ihl H n v I x"* n rvt ** m tet [ 34* mrt'*'t ffi * g: * t"rlt ir r r:r it lL <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINOR violations noted in the "Notice to Comply" in the attached lnspection 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 />thebottomofthisformwithin30daysofreceiptofthelnspectionReport, HSC25404.1.2(c)(1) <br />All corrections to other violations noted in the attached lnspection Report (lR) or Continuation Form, or disputes to any <br />violations, are to be submitted using this certification and returned to EHD within 30 davs unless otherwise specified in the <br />lnspection 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 />For this certification to be complete, tne operator orthe site must inctude: <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. Operator'scertification <br />lnspection Date: October 22,2A24 lnspected By: ALBERTO FERNANDEZ <br />Facility Address:2424 W TURNER RD, LODI CERS lD: 10181595 <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in the lnspection Report from the above-mentioned inspection date. <br />2. I have personally examined the following documentation submitted as proof ol coryy'liance FOR EACH VIOLATION <br />and I believe the information to be true, accurate, and complete', ,/\-/ <br />__Photos _Paperwork Statement <br />I am authorized to submit this certification on behalf of the Respondent. <br />I am aware that there are significant penalties for submitting false information, including the posslbility of a fine and/or <br />imprisonment for known violations. (HSC 25191 ) <br />x,," .Q#tuzr{ =f-bDFlT ,,,," V&tftg.e-.&. <br />Signature:Da,": | 0 -7)-2-\)