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t <br /> Environmental Health Department <br /> S a N JA Q lJ I N <br /> W _ _ <br /> C 0 LJ 1\1 I <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 form 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 corrections to other 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 30 days unless otherwise specified in the <br /> Inspection Report. HSG 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/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date . December 18 , 2018 Inspected lay : ZUNA BARKER <br /> Facility Address : 1400 E VICTOR RD , LODI CERS ID : 10181325 <br /> 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 /> and I believe the information to be true, accurate , and complete: r <br /> Photos Paperwork V/ <br /> 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: r Title: saki <br /> Signature: _ Date : <br /> ' 2 ��1 - mai ( W a s C-� fa6ftr Ryan s-I 4+i n9 no fi- Com Lifim <br /> quy <br /> hmp <br /> � 31a Imd� � sS�ta . tr art✓ <br /> .. �4 �' � repair huy �► 'fi?cecv�eo�. 1 s <br /> X20 a� P rocG5S 1a5 huh 5i& Wl+ C a r f Ord <br /> OV2X �1,� r000 • ���04 <br /> 1868 E . Hazelton Avenue j Stockton, California 95205 j T 209 468-3420 j F 209 464-0138 [ www.sjcehd . com <br />