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Sep 22 10 12: 20p Eng�eered Automation (209)68-0645 p. 2 <br /> 002454 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Tefep sone:(209)488.3420 Fax:(209)488.3433 Web:www sioov orolehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MLILOR violations noted in the "Notice to Comply"in the attached Inspection Report must be <br /> corrected 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 form within 30 days of receipt of the <br /> Inspection Report. <br /> All corrections to Other violeti n 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 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with falling to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete the <br /> ust include: <br /> operator A statement documenting what corrective actions were taken o owill be takeenthe site rfor each violation i <br /> e Copies of sample resutts/manifestaAraining recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> e O rator's certification i <br /> Inspection Date: C)3 �� Inspected By: , C <br /> Facility Address EPA ID#: CRCLOZ(o j�l2q <br /> i certifyunder d <br /> penalty of law that: <br /> I <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•informationto be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> I <br /> 4 1 arrt aware that there are significant penalties for submitting false information, inducing the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name- T-nle: ()W OC- <br /> Signature" <br /> END 22.02-005 Rev ae/oB <br />