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SAN JOAQIfIN <br />Environmental Health Department <br />RETURN TO COMPLIANCE CERTIFICATION <br />Arr} MINOR violations not&d m the "Note to Cormplyr' In the atoc;nsd Inspeotian Resort must be cormcled withinZ, of <br />receipt of IhiS inr-Pi;C W_ This cedificat9x form must bo subrr;lttad to She EnvirQnmenMI Health Dapartm-ant (EH D) address at <br />the boltorn of this fon, within 3o days of receipt of the Inspactiorr kopor._ H.5C 254[64,1,2(cX1) <br />All carreetiorm tip pth;f_ya taR_. tions noted in the attached Inopeirfion Report (11R) or Continuation Fnrrre, 8r ¢ispU#eg to any <br />violabwiri, are to be subrnified using this cer7ifcatlon and Wu mid tp :EHp ff t�ifj 3. days unlaffA otherwise spaLci5ed in the <br />InspeCHM R-9port. H5C 25185(cX3) <br />Note: All EHD staff time associated with failing to tompty by tIve above noted dates will be <br />hilia d at the ctirrent hourly rate. <br />For this certifiration to be complete, the operator rf rt- site must lincl - <br />A statcmc-1I doeumanting what Wrrai; Ve actions were taken of w,ll tM takGri far each viAlatlon <br />Copies of sample rasults,+marlifiestaAraining recondsiother appropriate paperwork. andror photos verdyi n4 omrecnticn$ <br />Operator's rxrtincat►bn <br />Inspection Date: May 21. 2020 Inspected Bir: SHEWIT VVQLDEAR EAY <br />Facility Address; 2680 REYNOLDS RANCH PKWY, LODI CERS 10: 10148151 <br />I certify under per+alty of law that <br />1. 1 #lave oarredM t1io u solations specified in the I nspectiorL Report from the ahov-&-mertipned inspects m data_ <br />2. 1 have personalty examined the failinwirbg documentation submitted as pfvof 4f rnmplian-c-:e FOR -EACH VIOIATIQK <br />and I believe the irdbvratibn to be true, ac%rate, and coo late: <br />Phct4s Paperwork 5tate+„ent <br />3. t am authorized to suhmit this c]edinratron on bohalrof the Ce:5parlderri, <br />4. 1 am aware fhat there are spgri leant pamltias for submi*ng falx anf rrtiatian, Including the po�sibiiity of a rine and,'or <br />imprisonment for known vlolab ns. (HSC 25191) <br />Name: Cott Cali Title, AGM <br />11/1812020 <br />Srgrtslu re:� 1 Dates <br />