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MAY-19-2008 08: 15 ?/ELEVEN, INC. P.03i06 <br /> 1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTPI.HFAUr-t DEPARTMENT <br /> Goo E.Main St,, Stockton,CA 95202-3029 <br /> Telephone. (209)468-3420 Fee (209)468-3433 Web:www.sigov,orgzehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> AnyIN IN�OR 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 /> Nate. All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate (598). <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 betaken for each violation <br /> 0 Copies of sample results/ma a i fests/train ing records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: oef 1�r�ti Inspected By: �1011^Aovkd uo^ Ftop_ <br /> Facility Address:-1-72-e; 6oAN CJL &jd, EPA ID#: . CAa.4$ t 4 -J 9 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. 1 have personally examined the following documentation submitted as proof of coinpliance TOR <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. (HSG 25191) <br /> � / Region Gasollne Environmental, <br /> NatTl�: Mty 4 Q WiEA4-5 Title: Compliance Manager <br /> Signature: Date: oS iG n <br /> vu rN I-Y-Al-Mr o A., l t1 fl7 <br />