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Sep. 11. 2008 '10 : 09AM" `°"'"" A" 5 J '"a° No. 0651 P. laoos/oos <br /> SAN JOAQt11N COUM 0I �s� O v Iv� <br /> SNvtRONM6NrAtHEALTH D)RAXIMENT u U <br /> 600 e,Main St.Stockton,CA 95202-3029 <br /> TE&Phener(209)468-3420 Fax:(209)468-3433 Web-,unyW&gy'o��d 2 2008 <br /> „ ... _......... ..t,WVIR,,AIMENT HEALTH, <br /> "ERA"li'SERVICE3 <br /> RETURN TO COMPLIANCL CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> Zreeted within 30 dam of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EMD)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 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 eomply by the above noted dates will be billed at <br /> the current hourly rate($98). <br /> For this certification t0 be CO2HP1CtC the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will betaken for each violation <br /> • Copies of sample results/manifests/training Twords/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: AV I A 0sk Inspected By; �}T�r( �I Ur <br /> Facility Address: 3'I CJai- Cli"tV-e _ EI'AM#: CALQnO <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 information to be true,accurate,and complete: <br /> X Photos---)4-Paperwork___X <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4, 1 am aware that there aro significant penalties for submitting false information,including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: DIS � �- 'Title: <br /> Signature: Date:',/ { f <br /> EHD 22,02-005 Rev 10-07 <br /> T00� 'Ylaa-N-31DId CoOZ 699 8T6 Xvd 9Z:90 800Z/TT/60 <br />