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Nov. 14. 2018 4:29PM 9 40 No. 2487 P. I <br /> San Joaquin County RECEIVED <br /> Environmental Health Department <br /> 0 <br /> 1868 East Hazelton Avenue,Stockton,California 95205-6232 1 4 2018 <br /> Telephone.(209)468-3420 Fax.,(209)468-3433 Web.www.sigov.oWL8hd <br /> ENVIRONMENTAL <br /> RETURN TO COMPLIANCE CERTIFICATION KFALTIq r®r-:PARTIVIFNT <br /> Any MINOR violations noted in the"Notice to Comply'in the attached Inspection Report must be g2[rgOed within 30 due,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 correct gl3g 19 9ther 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 unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Note: All EMD 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 most Include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample resuh/manifestsitraining recordslother appropriate paperwork,and/or photos verifying corrections <br /> Inspection Date: October 16, 2018 Inspected By: STACY RIVERA <br /> Facility Address. 975 S FAIRMONT AVE, LODI -CERS ID: I0180611 <br /> I certify under penalty of law that: <br /> 1, 1 have corrected the violations specified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> I believe the Information to be true,accurate,and complete: <br /> _Photos____Ylaperwork L-l"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 and/ <br /> imprisonment for known violallons. (HSC 25191) <br /> Name: 1`�""rl'CA Title: Fo�, <br /> Signature: 11 Date: / /.,.— I <br />