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SAN J O A U U I N Environmental Health Department <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 /> at the top of this form within 30 days of receipt of the Inspection Report. HSC 25404.1.2(cx1) <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 EHD within 30 days unless otherwise specified in the <br /> Inspection Report. HSC 25185(cx3) <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 /> Forthis certification to be complete, the operator of the site must include: <br /> A statement documenting what corrective actions"retaken or will be taken for each violation <br /> Copies of sample results/manifests/training recordsrother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: March 27, 2019 Inspected By: CESAR RUVALCABA <br /> Facility Address: 2131 W TURNER RD, LODI CERS ID: 10183001 <br /> 1 certify under penalty of law that: <br /> 1. I am working with a consultant to correct the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. Once corrected by a licensed PE,I will personally examine the documentation as proof of compliance FOR EACH <br /> VIOLATION and submit the plan revisions to to San Joaquin County EHD: <br /> PhotosPaperwork X 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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: Brooklyn Saylor Title: Compliance Manager <br /> Signature:_ 9266 2 Date: _04272019_ <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjoehd.com <br />