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I I JOA U I N Envirortmental Health Department RETURNS O COMPLIANCE CERTIFICATIO14 Any MINOR vi I blations n ted in the"Notice to Cd ply"in the attached Inspection Report must be correcte J within 30 days of receipt of thisnspection This certification form; ust be submitted to the Environmental Health Department(EHD)address at the bottom of this form within 30 days of receipt,cf the Inspection Report. HSC 25404.1.2(c)(1) All corrections to other violations noted in the at! checd Inspection Report(IR)or Continuation Form,or dis Utes to anv violations, are to be submitted using this certifio on and returned to EHD within_ 30 days unless otherwise specified in the Inspection Re ort. HSC 5185(c)(3) Note: All EHD taff time associated with failing to comply by the above noted dates will be i billed at the urrent hourly rate: For this certifice tion to be com tete, the operator of the site must include: A stat�ment do umenting what corrective actions were taken or will betaken for each violation Copies of same e results/manifests/train g records/other appropriate paperwork, and/or photos verifying corrections Oper tor's certii cation Inspection ate: October 21, 2020; Inspected By; CAROL PRESTO Facility Adc ress: 20 W TURNER j##A LODI CARS ID: 10180633 1 certify under penalty of law that: 1. I hay, corrected the violations specifieQ in the Inspection Report from the above-mentioned insp ction date. 2. 1 have persona ly examined the following documentation submitted as proof of compliance FOR :-:ACH VIOLATION and 1 believe the information to be true,,i accurate, and complete: Photos Paperwork Statement 3. 1 am authorizec to submit this certificate n on behalf of the Respondent. 4. 1 am aware tha there are significant ponalties for submitting false information, including the poss bility of a fine and/o,imprison far known violation . (HSC 25191) Name: 01-�.ent c✓�v� �]�iCt.)Title: O L- ,t- Signatu e: Date: �i.\ a