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0 <br /> Environmental Health Department <br /> SANJOAQUIN <br /> COUNTY— <br /> Greatness qr*Ws here, <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 ibrm 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(c)(1) <br /> All correctIonsjQother Aglations noted in the attached Inspection Report(IR)or Continuation Fonn,.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(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/manifesMraining recordslother appropriate paperwork,and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date: —November 08, 2018 Inspected By: ZONA BARKER <br /> Facility Address: 880 E VICTOR RD, LODI CERS ID: 10181491 <br /> I certify under penalty of law that <br /> 1. 1 have corrected the violations specified in the Inspection Repo rt from the above-mentioned inspection date. <br /> 2. 1 have personally examined the fbIlowing docu,Mentation submitted as proof of domptiance FOR EACH VIOLATION <br /> and I believe the information to be true,accurate,and complete: <br /> V-Photos L/ 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 <br /> and/or imprisonment for known violations. (HSC 25191) <br /> Name: c Q Title: MAN A ri-T f—::- <br /> Date: <br /> Signature: <br /> 44fZ 17 Z <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 1 T 209468-3420 1 F 209 464-0138 1 www.sjoehd.com <br />