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SAN JOAQUIN COUNTY RECENED <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 Q ZQ�2 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ N() <br /> E iRANM AEN LT -�TH <br /> PERMITISERVI <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report (IR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate($122). <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 <br /> verifying corrections <br /> • Operator's certification I � / <br /> Inspection Date: q ( I -I l?-Ol�t. Inspected By: M U Vl i �(P� I v0. �v <br /> Facility Address: QS D M4�vyq, , �ut✓np�L� EPA ID#: C�,L 0006 O 4—R 0 <br /> gs37o <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I bb leve the information to be true,accts;ate, and complete: <br /> v Photos ` Paperwork `//Statement <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) q� <br /> Name: A i�,CbLt I <br /> ' <br /> w/, 691i1 Title: I2Vyvli-A ✓etAVIA G( r <br /> Signature� Date: 0 ZD <br /> �"ZEHD 22-02-005 Rev 08//10 <br />