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SEP. 14. 2009 3:49PM INTE STATE TRUCK CTR 'NC. 649 P. 2 <br /> SAN JgAQUIN PvUNTY <br /> ENVIRCNMENTA Hf'ALTH DEPARTMENT <br /> 600 feast Main 5t*t, pktor, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax{(209)468-3433 Web:www.siaov.ora/ehd <br /> RETURN TO CON1PWANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply" In the attached lhspection Report must be <br /> corrected within 30 days of receipt of this inspecti¢n , This certification form must be submitted to the <br /> Envirbnmentaf Health Department (EHD) addreeO at the top of this form within 30 days of receipt of the <br /> Inspection Report. <br /> All cn�r estions to other violations noted in the att�phed Inspection Report (IR) or Continuation Form, or <br /> disputes to any violations, are to be submitted us pg this certification and returned to EHD within 30 days <br /> { unless otherwise specified in the Inspection Re,p9J , <br /> Note: All EHD staff time associated with failino to comply by the above noted dates will be <br /> billed at the current hourly rate ($1 'p.). <br /> For this Certification t0 be coM let,e the operator of the site must include: <br /> A statement documenting what corrective aprons were taken or will be taken for each violation <br /> • Copies of sample results/manifests/training'rpeorop/ether appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: f � Q Inspected By: .4 V&� ALI <br /> Facility Address: ] EPA ID#: �2 LE7Iq 7q <br /> I certify under penalty of law that: <br /> 1. 1 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 .0hplf of the Respondent. <br /> 4. 1 am aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine.and/or imprisonment fir k'jpawri violations. (HSC 25191) <br /> { <br /> Name: < 1" _ �yC�,S��f Title: �v°c . Mh-Al* <br /> Signature: Date: / 1Vq <br /> EHO 22.02.005 Rov 08!08 <br />