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FROM TRUCK LUBRICATION CO FAX NO. : 209 833 6046 Tan. 11 2011 12:41PM P9 <br />o-( <br />SAN JunQul C[►U�Tv RECEIVED <br />fiNV1RONMEN]f.�l. }[Li:�f:l'll ISI?PiVt'iMF:N l <br />600 Fast Main Street, Stockton, ('A 95202-30,29 <br />Telephone: (209) 468-3420 I -ax: (209) 468-3433 Weh: www.s cfi4i <br />FEB 0 8 2011 <br />RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <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 <br />Inspection Date:—' I I 1 I_... _ . <br />Facility Address: <br />I certify under penalty of Iaw that:r <br />inspected By: <br />EPA ID#: -W b n a 1� 4 g 0- <br />I. I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and 1 believe the info/Paperwork <br />ation to be true, accurate, and complete: <br />Photos tatemcnt <br />L <br />3. I 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 <br />possibility of a fine and/or imprisonment for known violations. (HSC 2519 1) <br />Name: L "'1 vl 6"Y <br />EHD 22-02-6 Rev 08/ 10 <br />Title: d U r <br />Date: o111 I /d <br />I <br />