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r C <br /> ln rp.)! 9 <br /> .if l y:: Jt i ' f • t VIA6• t <br /> Iry 0 <br /> SAN J O A Q U I N Env� � � l n � ' ` iah Department <br /> .: �::.�-:. ; f•l ti� <br /> go Vp <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MWOR violations noted In the "Notice to Comply' in the attached inspection Report must be 9prracted within 30 dayA of <br /> receipt of this inspection. This certification form must he submitted to the Environmental Health Department (EHD) address + <br /> the bottom of this form within 30 days of receipt of the Inspection Report, HSG 25404.1 >2(c)(1) <br /> All corrections tp other vlolattoo[ig noted In the attached Inspoetlon Report (1R) or 0ontinuation Form, or disputes to any <br /> violations, are to be submitted using this certification and returned to SHO within j Q,days unless otherwise specified In the <br /> InspeottonReport. HSO2tif85(c)(8) <br /> Note: All END Ataff time associated with failing to comply by the above rioted dates will be <br /> billed at the current hourly rata, <br /> For this Certification t4 be complete, the operetorofthesitamustinolude; <br /> A etafament documenting what corrective actions were taken or will betaken for each violation <br /> Coplas of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date: June 13 , 2019 lnspeoted By: PAUL PISO <br /> Facility Address: 1721 C CHEROKEE L& LODI � Ci~ C�� It?; 10180631 <br /> .40 <br /> I certify under penalty of law that: <br /> 1 . i 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; <br /> hotos X paperwork X 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 talse Information, Including the pwall)iltty of a tine <br /> and/or Imprisonment for known,vtolatlons, (HSQ 26,101 <br /> Name; Toni VonRuden _ Titin. Environmental Manager <br /> ulgnat re. __. . .Date: 6) <br /> A 'I. <br /> VA <br /> 3 2 (l CI <br /> WA C . Hazelton Avelino i Stockton , California 952051 T 208 46t3�342o I F 209 464 I �e & L 1 I EAIw:tµ �I <br />