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Oct, 24. 2007 10:48.AM 0 N'o, 0722 P. 5 SAN JoAQUIN COUNTY C pa 15. MA cel ENvI.ONMEWAL HEALTH DEPAPTr ENT Stoelton, CA 95202-2709 Telephone: (209) 468-3420 Pax. (209) 465-3433 WEIi: www.si ov.orgle td RETURN TO COMP .LANCE CERTIFICATION Any MINOR violations noted in the' Notice to Comply' in the attacked inspection report must be corrected within 30 dans of receipt of this inspection This certification farm must be submitted to the Environmental Health Department (HHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other violations rioted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 50 da unless otherwise specified in the. IR. For this certification to be complete the operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, anchor photos verifying corrections • Operator's certification InspeetiOn Date: Q 0 7 Inspected By: a.v Facility Address: �f7 EPA ID#:_�_'.�1�' 57TOC/<7-0Mi C I certify under penalty of law that: 1. 1 have corrected the violation specified in the Inspection Report from the above-mentioned inspection slate. 2. I have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: Photos ✓ Paperwork vl' Statement 3. I am authorized to submit this certification on Behalf of the Respondent. 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) Name:— Title: T ,2irli,�,QC t5v.�c,2 Date: % % Wo -7 EHD 22-02-005 Rev 12-04