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S • <br /> SAN JOAQUIN COUNTY <br /> H�NMENTAL HEALTH DEPARTMENT <br /> st Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fan:(209)468-3433 Web:wwwso <br /> j e vRECEIVED <br /> ore%hd <br /> 9I 013 <br /> RETURN TO COMPLIANCE CERTIFICATION ENVIRONMENT,6114EALTH <br /> PERMIT/SERVICES <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 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(9.fM <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: J,? -/U /a Inspected By: Te 4 aon q <br /> Facility Address: o?a/ N•WIlSoIV Wct 1/ EPA ID#:ChL 92o '7967V <br /> I certify under penalty of law that: <br /> have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> �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 /> 0 I am authorized to submit this certification on behalf of the Respondent. <br /> 40 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:Tg e, Title: Mono 4 r,J- <br /> Sign Date: <br /> EHD 2 -02-00 0 <br />