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Octbl1411:42a J&S Truck Repair 2099449487 p.1 <br /> Tael RECEIVED <br /> + SAN JOAQUIN COUNTY <br /> amu' j���(r ;� i ENVIRONMENTAL HEALTH DEPARTMENT OCT O 12014 <br /> 1868 East Hazelton Avenue, Stockton, califomia 95205-6232 1 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www sicov.orgfehd ENVIRONMENTAL <br /> 060T111chrr <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report most 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. HSC 25404.1.2(c)(1) <br /> All corrections to other violations 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. HSC 25185(c)(3) <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 /> 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 resutts/manifesls/training recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> . Operators certification <br /> Inspection Date: q/ 4/)4 Inspected By: ` s V <br /> Rd.Facility Address: ��C, % l»O !�Rd. EPA ID#: <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. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. [ am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine andlor imprisonment for known violations. (HSC 25191) <br /> Name: l Y Title: �/l1�2 YIB1 a �' <br /> Signature: Date: — —Z <br /> y <br /> EHD 2242-005 Rev OW 19112 <br />