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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:wwwAgov.ore%hd <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 vto ahons,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($122). <br /> For this cert1 lCatlon toe COm�lete the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will p taken for each violation <br /> • Copies of sample results/In fests/training records/other appropriate paperwork and/or photos <br /> venfymg corrections <br /> • Operator's certification <br /> Inspection Date: April 12, 2011 Inspected By: Garrett Backus <br /> Facility Address: 7373 West Lane, Stockton EPA ID#: CAD983600594 <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. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 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: t L� Title: 0-d(36_7��t4 <br /> Signature: Date: (( <br /> EHD 22-02-005 Rev 08/10 <br />