Laserfiche WebLink
APR-14-2009 22:42 FROM: T^!4683433 P.1/8 <br /> SAN JOAQUIN COUNTY �C;S/ <br /> ENVIRONMENTAL HEALTii DEPARTMENT <br /> 600 E.Main St.,Stockton,CA 95202-3029 1 AV <br /> Telephone:(209)468-3420F= (209)468-3433 Web.wwwsigo_y.Qrg/ctu9 AUG <br /> '9A A, <br /> y'� yL, <br /> RETURN TO COMPLIANCE CERTIFICATIbflcFp�yer q<Nry <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be T <br /> cQnsrctcd within 30 days of receipt of this inspection, This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this forst 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 comply by the above noted dates will be billed at <br /> the current hourly rate (5122). <br /> For this certification t0 be C011113Iete 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:-T4 v y -TK 6/1 <br /> Facility Address: -711 R' uj' ( I EPA ID#: CAL 0002(e11 j-)3 <br /> -Td i G <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. 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 <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 2519 1) <br /> Name: .J4r,Loo3 I 7�fKpSmt j2, Title: ou^Wv- <br /> Signature: Date: &A I r <br /> EHD 22.02-005 Rev 08/10 <br />