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U5/16/2008 FRI 15: 02 FAX 2094683433 SJG EHD 0002/002 <br /> 1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTti DEPARTMENT <br /> 600 E. Main St„Stockton,CA 95202-3029 <br /> Telephone: (209)468-3420 Fax.(209)468-3433 Web,www.sogov.orgichd <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 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 ($98). <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: cef Q !bis Inspected By: 1p al mo"d U0^ FL,,_ <br /> Facility Address:_ 272.x` 6 cdxq 0,� Bwal, EPA ID#: ca,o Q8 r 4(,S-1of z <br /> I certify under penalty of law that: <br /> I. 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 infonnation 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 /> Region Gasoline Enuironmental <br /> Compliance Manager <br /> Name: 00 LA 41 Title: <br /> Date: ©Sh 0 k <br /> Signature: <br /> r T-1 1)1).n) nnc D.— 1 n nn <br />