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Oct 26 2010 7: 36RM COX BROS TIRE SERVICE 8350401 p. l <br /> h <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT Q <br /> �' 600 East Main street,Stockton,CA 95202-3029 Cr 2 <br /> Telephone:(209)468-3420 Far:(209)468-3433 Web:www.sj¢ov.or� 62010, <br /> NVIO�1,,�JC <br /> `JrA; <br /> TURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR vii lations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> correct w 0 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmentzll ealth Department(EHD)address at the top of this form within 35 days of receipt of the <br /> Inspection Re port. <br /> All correcti other violations noted in the attached Inspection Report(IR) or Continuation Form,or <br /> disputestolinly lations,are to be submitted using this certification and returned to EHD within 30 days <br /> unless othe is 11111;specified in the Inspection Report. <br /> Note: All L taff time associated with failing to comply by the above noted dates will be billed at <br /> the current t iiii y rate($122). <br /> For thisleel lflcatlon to be complete the operator of the site must include: <br /> • A swer int documenting what corrective actions were taken or will be taken for each violation <br /> • copies44sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verif}in, corrections <br /> • <br /> 'Opt tos certification <br /> Opeto, <br /> Inspection I Inspected By: C <br /> Facility Ad ss: CCI >E. [ ++I EPA ID#:�j�G, 2 Drat o?� <br /> j <br /> I certify nOr penalty of law that: <br /> 1. I haIve c0iTected the violations specified in the htspection Report from the above-mentioned <br /> insoentiiin date, <br /> 2. I haw sonally examined the following documentation submitted as proof of compliance FOR <br /> EACI I I IOLATION and I believe the information to be true,accurate, and complete: <br /> Photos x PaperworkStatement <br /> 3. I art u , prized to submit this certification on behalf of the Respondent. <br /> 4. I am awire that there are significant penalties for submitting false information, including the <br /> posh i of a fine and/or imprisonment for known violations.(HSC 25191) <br /> Name Y r v vt. S r Title: O w ru✓ <br /> Signa e:', Date: /d 10zhz7 <br /> EHD 22-0210 5!ev 08/10 <br /> ati u ; i' <br />