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From: • 06/j/2010 19:22 #143 P.001/012 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEAL'T'H DEPARTMENT <br />304 East Weber Avenue, P Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fox. (209) 468-3433 Web: www.sjgov.orglehd <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 (IR) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days <br />unless otherwise specified in the IR <br />- <br />For this certification t0 be COmplete the operator of the site must include: <br />A A statement documenting what correctiv' tions were taken or will be taken for each violation <br />® Copies of sample results/manifestbirds/other.appropiat>paperwork, and/or photos <br />verifying corrections <br />• Operator's certification JUN 10 2010 <br />SAN COUNW <br />Inspection Date: i o 10 }^ g� �, <br />� y.67C P <br />Facility Address: X30 4- Wc-z - r z EPA ID#: 1--I4 1 Sof Z <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 info 'on 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: <br />EHD 22-02-005 Rev 12-04 <br />Title: 7-4 <br />Date: <br />