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Environmental Health Department SANSJOAnUIN <br /> c. (-)ur=1TY AMENDED-2 <br /> RETURN TO COMPLIANCE CERTIFICATION 1/27/2026 <br /> Any MIND R 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 at <br /> the bottom 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. HSC 25165(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 corrections <br /> Operator's certification <br /> Inspection Date: January 24, 2025 Inspected Sy: CAROL PRESTO <br /> Facility Address: 420 W KETTLEMAN LN, LODI CERS ID: 10181407 <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentloned inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATIONI. <br /> and I believe the information to be true, accurate, and complete: <br /> Photos-Paperwork_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 and/or <br /> Imprisonment for known violations. (HSC 25191) <br /> Name: Wn, a Title: D'pt.7`r2 kl&(� � covvnQyayv/ �e <br /> Signature: � � T- Date: *2 - }-1 -202, 5 <br />