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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton, California95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sigoy.orq/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection 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 <br /> the top 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 EHDwithin 30 days unless otherwise specified in the <br /> 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 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 results/manifests/training recordsrother appropriate paperwork, and/or photos verifying correction. <br /> Inspection Date: ch z3, Z01L' Inspected By: ✓ELOSG <br /> Facility Address: X30 E VICTOR RD. LODi EPA ID: <br /> 71have <br /> y of law that: <br /> ted the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> nally examined the following documentation submittedas proof of compliance FOR EACH VIOLATIO <br /> information to be true, accurate,and complete: <br /> Photos X Paperwork Statement <br /> 3. 1 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 possibility of a fine ancV <br /> imprisonment for known violations. (HSC 25191) <br /> Name: �)KiJe- C(r �a off Title:C-0. 4 lock/- V,-(G rti4� e� <br /> SignatureDate: Y/7 <br /> Y.:�.��es. <br /> APR 0 7 2016 <br /> *'Ilaul�r�` <br />