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04/20/2007 12:22 20946e 13 <br />SAN JOAS <br />ENviRONMENTAL <br />364 East WeW Avenue, P <br />Telephone: (209)468-34ZO Par. (: <br />RETURN TO <br />RECEIVED 04/20/2007 00:25 <br />EHD <br />Ifto <br />i COUNTY <br />XTK DEPARTMENT <br />)r, stack=4 CA 95202-2708 <br />468-3433 Web: www-sieov ore/efad <br />CERTIFICATION <br />PAGE 05 <br />Any >\'III`IOR violations noted in the "Notice to Co y' in the attached inspection repot[ lrlttst be <br />corrected within 30 days of receipt of this. inspection. This certification foram must be submitted to the <br />Environmental Health DcPmtneut (EM) address at a top of this form within 35 days of receipt of the <br />inspection report. <br />All corrections to, violations noted in the attact <br />disputes to any violations, are to be submitted using <br />unless otherwise specified in the IR. <br />For this certification to be ctimplet <br />• A statement documenting what corrective a <br />• Copies of sample results/manifests/training <br />verifying corrections <br />• Operator's c;1 ifrcation <br />Inspection Date: "OSS —O t- <br />Facility Address: 3a� N' SiAn'1S�t, <br />I certify under penalty of law that: <br />1. I have corrected the violations specified in t1 <br />inspection date. <br />2. I have personally examined the following do <br />SACH'VIOLATION and I believe the inion <br />Photos <br />3. 1 am authorized to submit this certification <br />4, 1 am aware that there are significant penalt el <br />possibility of a fine and/or imprisonment for <br />Name: �A t M kg -V <br />SHD 22-02-005 Rev 12-04 <br />Inspection Report (IR) or Continuation Form, or <br />s certification and returned to EHD within 60 days <br />operator of the site must include: <br />were taken or will be taken for each violation <br />Is/other appropriate paperwork, and/or photos <br />Inspected BY: 1e,4 / VON L <br />EPA ID#: <br />Inspection Report from the above-mentioned <br />Cation submitted as proof Of compliance FOP, <br />to be true, accurate, and complete: <br />Statement <br />behalf of the Respondent. <br />submitting false infomaation, including the <br />vo violations. (FISC 25191) <br />Title: OI�'N 12 <br />Date: 4 -,9S --,O � <br />