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From:MELENDEZ ENT. 2094661164 08/0012007 14:41 #382 P.002/005 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue, 3`4 Floor,Stockton,CA 95202-2708 <br /> Telephone: (209)468-3420 Pax:(209)468-3433 Web:www.sjgov.org/ekal <br /> i.. <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 day$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 60 days <br /> unless otherwise specified in the IR. <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: Inspected By: d� <br /> r <br /> Facility Address: ��A' f S'2a EPA ID#:C�}2. op0'j / }S� <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 believe the 7fio7rmafto be true, ace e, and complete: <br /> Photos ork 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) <br /> Name: Ic� c Title: �tX. <br /> Signature: Date: i 0 <br />