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San Joaquin County <br /> Environmental Health Department <br /> 1868 East Hazelton Avenue, Stockton. California95205-6232 <br /> Telephone: (2('9)468-3420 Fax: (209)468-3433 Wet:www.sigov.orci/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Note e to Comply', in the attached Inspectioti Report must be corrected within 30 days of <br /> receipt of this inspection. his certification form must be submitted to the Environmental Health Department (EHD) address <br /> the top of this form within 20 days of reclNipt of the Inspection Report. HSC 254 4.1.2(c)(1) <br /> All corrections to other viol itions noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any <br /> violations, are to be submilted using this certification and returned to EHD withir 30 days unless otherwise specified in the <br /> Inspection Report. HSC 2 185(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 hourily rate. <br /> For this certification to be complete, the operator of the sit must include: <br /> A statement docum nting what corrective actions were taken or will bet ken for each violation <br /> Copies of sampler sults/manife is/training records/other appropriate Paperwork, and/or photos verifying corrections <br /> Inspection Date: —Sezitember 17, 2018 <br /> Inspec:ERS <br /> d By: STACY RIVERA <br /> Facility Address: 20 TURNS RD, LODI <br /> ID: 10180633 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations sp cified in the Inspection Report from the above-mentioned inspection date. <br /> 2. 1 have personally e amined the fc Ilowing documentation submitted as proof of compliance FOR EACH VIOLATION <br /> believe the informs ion to be true, accurate, and complete: <br /> Photos Paperwork\Statement <br /> 3. 1 am authorized to s bmit this ce ification on behalf of the Respond/ent. <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 violations (HSC 25191) <br /> Name: f C f/ <br /> Title: <br /> Signature: 4 711 <br /> Date. (� <br /> L <br />