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Apr 08 09 09: 09a tom price 209-365-6781 p. l <br /> 002454 _. <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Ta/ep',one:(209) 468-3420 Fan:(209)468-3433 Web:www.s6goy.org/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> APR 0 8 2009 <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 subrWilidAtube COUNTY j <br /> Environmental Health Department (EHD) address at the top of this form within 30 days ofr OTA' <br /> Inspection Report. H�"�' Drt EPA8TMENT <br /> I <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 specked in the Inspection Report. <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 /> i <br /> For this certification t0 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 /> • <br /> Operators certification <br /> Inspection Date:L— `G�� Inspected By: A 5 cis"�/i <br /> Facility Address:Z�20 S• 1�1�UtG yr cQ, EPA ID#: CIqL 000.26752-L2 I <br /> L� I <br /> C� <br /> I certify under penalty of law that: G � tV j <br /> I <br /> 1. I have corrected the violations specked in the Inspection Report from the above-mentioned i <br /> inspection date. <br /> 2 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true, accurate, and complete: <br /> Photos_Paperwork Statement i <br /> 3. lam authorized to submit this certification on behalf of the Respondent. <br /> I <br /> 4 1 am aware that there are significant penalties for submitting false information, including the <br /> passibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Ti LQ- Title: <br /> Signature, /L. Date* j 0Z <br /> EHD 22-02-005 Rev 08/08 <br />