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.11 11:03 Van De Pot 1 >> 2094683433 P 1/2 <br />San Joaquin County 0 " ' <br />Environmental Health Department L <br />1868 East Hazelton Avenue, Stockton, California 95205-6232 <br />Telephone: (209) 458-3420 Fax: (209) 468-3433 Web: tMw,2igg–y,Pr-qL"h AUG i I 20i,,i <br />mn <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINQfi violations noted in the "Notice to Comply' in the attached Inspection Report must be ggr[ggteg within ag days of <br />receipt of this inspection. This certification form must be submitted to the Environmental Health Department (EHO) address; <br />the top of this form within 30 days of receipt of the Inspection Report HSC 25404.1.2(c)(1) <br />All correctionst other&Iatign; 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 EMD &ftWaV �W 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/manifeststtraining recordstother appropriate paperwork, and/or photos verifying corrections <br />Ins pectionDate: June 24,2016 Inspected By: ARTS VELOSO <br />Facility Address: 351 N BECKMAN RD, LODI EP A 10. CP L C 700 <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 —1 --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 a <br />Imprisonment for known violatioris,_(H$C. 25191) <br />Signatu <br />