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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street,Stockton,CA 95202-3029 Tele one:(209)468-3420 Fax:(209)468-3433 Web:www.sjgov.org/ehd RET TO COMPLIANCE CERTIFICATION Any MINOR violations no ed in the"Notice to Comply" in the attached inspection report must be corrected within 30 days o receipt of this inspection. This certification form must be submitted to the Environmental Health Dep rtment (EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other vio ations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, 4re to be submitted using this certification and returned to EHD within 60 days unless otherwise specified i the IR. For this Cert1f1Cat1 n t0 be Complete the operator of the site must include: • A statement docum nting what corrective actions were taken or will be taken for each violation • Copies of sampler sults/manifests/training records/other appropriate paperwork, and/or photos verifying correctio • Operator's certifica ion Inspection Date: `7` ?� b Inspected By: Facility Address: J-r' EPA ID#: 3e2/f-v I certify under penalty o law that: 1. 1 have corrected the iolations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally ex mined the following documentation submitted as proof of compliance FOR EACH VIOLATIO and I believe the information to be true, accurate, and complete: Photos Pa ork Statement 3. 1 am authorized to smit this certification on behalf of the Respondent. 4. 1 am aware that therjaid/or re significant penalties for submitting false information, including the possibility of a fine imprisonment for known violations. (HSC 25191) Name: 11"of/!V ^76o G L�� Title: � ti Signature: Date: O.i / U EHD 22-02-005 Rev 05/07