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0,-w-n" res vdoc )o IE <br /> SAN JOAQUIN COUNTY RECEIVD <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1888 East Hazelton Avenue, Stockton, California 95205.6232 JUL .11 2014 <br /> Telephone;(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the <br /> 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 <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection 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 t0 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 /> e Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> . Operator's certification <br /> Inspection Date: 7-11-2014 Inspected By:ARIS VELOSO <br /> Facility Address:420 W_ LODI AVE,LODI,CA EPA ID#: CAL000396434 <br /> I certify under penalty of law that: <br /> 1 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos ✓ Paperwork 1�/ Statement <br /> 3 I 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 <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> LSign <br /> e: e Titleatur ate: —ply <br /> EHp 22-02-005 Rev Wig/12 <br /> T/T:ae pd ££b£89b:01 :wo.JJ L0:£0 bT02-2T-_1Af <br />