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0 SAN JOAQUIN COUNTY • <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web:www.sjtzov.org/ehd <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 /> AlF corrections to other violations noted in the attached Inspection Report(IR)or Continuation Form, or <br /> disputes to any violations,are to a 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($122). <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 results/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: March 18, 2011 Inspected By: Garrett Backus <br /> Facility Address: 2303 West Lane EPA ID#: CAL000352849 <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. I 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 behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information,including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: 1-16 M i : Title: C u//11(72, <br /> Signature: )cit �'��-�-- Date: -3 - I & - <br /> EHD 22-02-005 Rev 08/10 �N� o(,ov� --E�tv -c`'vd f-r l k ,i <br /> S e vv i lc__- �.Gtu,S . 1✓vi�V S 0KA e-'�'J 1.-erC �c'rn ,v,'S cel / �� <br /> tiv 'W tib I-6-c <br /> 1>� <br /> ru�dr , 1 <br /> L�b1,- <br />