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12/07/2007 PRI 10: 27 FAX 2094683433 SJC EHD --- 7-Eleven IQJUG0/UUU <br /> SAN JOAQUIN COUNTY <br /> E1MR0NMENTAL HEM.Ti'i DEPARTMENT <br /> 600 E. Main St., Stockton,CA 95202-3029 <br /> Telephone; (209)468-3420 Fax: (209)468-3433 Well:www.sjgov.orgletad <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR 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 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted in the attached Inspection Report 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 failing to comply by the above noted dates will be billed at <br /> the current hourly rate ($98). <br /> For this certification to 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, and/or photos <br /> verifying;corrections <br /> • Operator's certification <br /> .Inspection Date: /,2-Z -U 7 Inspected By: .242:V t202 E/uZ_ <br /> Facility Address: 'YID/ /,a A(f EPA ID#: eA/) 95?/- <br /> I <br /> g1I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection elate. <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 P/ _Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4, 1 am aware that there are significant penalties for submitting faise information, including the <br /> possibility of a fine and/or imprisonment for known violations_ (HSC 25191) <br /> Region Gasoline Environmental <br /> Name: Ian Moorhead 'Title: compliance Manager <br /> Signature: Q_a' - ,ei Tate: <br /> EHD 22-02-005 Rev 10-07 <br />