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0`6/25/2012 11:00 2093344684 #4296 P.001 /004 <br /> .0024 \ • <br /> SAN JOAQUIN COUNT <br /> ENVIHONMENTAL HEALTH DEPARTMENT <br /> 600 East kIn.Street Stockton,CA 95202-3029 <br /> 01e one,(209)488-3420,Farr.(209)468.3438 Web.We6L - ov.ainlehd <br /> JUN 2 5 2012 <br /> RETURN TO COMPLIANCE CERTIFICATION V <br /> Any MINOR violations noted in the"Notice to Comply°in the attached Inspection Report must be <br /> corrected within 30 des 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 /> i <br /> i <br /> All corrections to other 'ov! lations rsotad 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 <br /> unless otherwise speed in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> I <br /> For this certification t0 be complete 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, andlor photos <br /> verifying corrections <br /> • <br /> Operator's certification <br /> Inspection Date: C' — Z Inspected By: 1 S <br /> Facili(y Address:.WW' lwwX�� EPA ID#: j <br /> h s 2-if v <br /> I certify under penalty of low that_. <br /> 1. 1 have corrected the violations speed 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 i <br /> EACH VIOLATION and I believe the Wormat- n to be true, accurate, and complete: <br /> ` i <br /> Photos Paperwork ✓ statement , <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4 lam aware thai there are significant penalties for submitting false information, including the I <br /> possibility o /fine and/or ior nt for known violations. (MSC 25191) i <br /> r <br /> Name; l r O (' Ole Title:- _ -- <br /> Signature' Date <br /> L i <br /> EKD 22-02-M Rev Oaft .�f <br />