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f 3 . <br /> _ &Iceaml <br /> � ��� � �"� ir� � Department <br /> SAN JOAQUIN <br /> : .; tai T , <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MIU0 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 /> the bottom of this form within 30 days of receipt of the Inspection Report, H5C 25404A 2 (G) (1 ) <br /> All corrections to other violations noted in the attached inspection Report (IR) or Continuation Porm , or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD i hi days unless otherwise specified in the <br /> Inspection Report, HSC 25185(c) (3) <br /> Note : Ali EHD staff time associated with failing to comply by the above noted dates wiil 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 betaken for each violation <br /> Copies of sample results/manifests/training recordsiother appropriate paperwork , and/or photos verifying corrections <br /> Operator's certification <br /> Inspection Date; June 13 , 2019 Inspected By: PAUL PISO <br /> Facility Address : 1721S CHEROKEE LNC LODI Ci~ RS ID; 10180631 <br /> 1 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 /> .Photos 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 false Information, including the possibility of a fine <br /> and/or imprisonment for known violations . (HSC_25191 ) , _ . . <br /> Name: Toni VonRuden Environmental Manager <br /> Title: 9 <br /> Signature: Date: <br /> 1858 E . Hazelton Avenue I Stockton , Califomia 952051 T 209 4W34201 F 209 464-0138 I www.sjcehd. com <br />