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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />Tele 600 East Main Street, Stockton, <br />phone: (209} 468-3420 Fax- (209) 468-3 33 Web: <br />2-3029 <br />AUG 2 2 201, <br />RETURN TO COMPLIANCE E'IVv1RON41 <br />Any Ml_ pR violations noted in the C c�RT1Fi A►T'lQN PERMI -E&TALC4L crj <br />corrected within 30 da e Notrce to Comply" . s <br />s of receipt of this ins ectionn.�n the attached Inspection Report must be must be <br />Environmental Health Department (EHD) p p this certification form <br />Inspection Report. )address a# the top of this form within 30 days Of reed to the <br />All correc#ions to other violations noted in thea y receipt of the <br />disputes to any violations, are to be submitted using this s <br />attached this <br />Inspection Report (1R) or Continuation Form, or <br />unless otherwise specified in the Inspection Report. rtification and returned to EHD within <br />30 da s <br />Note: All EHD staff time associated with failing to c <br />billed at the current hourly rate. omply by the above noted dates will be <br />For this certification to be com l <br />• A statement documenting what corrective actions <br />were � operator of the site must include: <br />• Copies of sample results/manifests/training records/otheaaen or will be taken far each violation <br />verifying corrections appropriate paperwork and/or photos <br />• <br />01erator's cert; <br />f cation <br />Inspection Date: 2 -18 -Zoll <br />Inspected By; <br />Facility Address: V�4q D Kv� <br />EPA 1D#: <br />1 certify under penalty of laky that: <br />1. 1 have corrected the v;o`aaons 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 compliance FOR <br />EACH VIOLATION and I relieve the information to be true, accurate, and complete: <br />Photos __4 -Paperwork <br />Statement <br />3. 1 am authorized to sudmihis certification on behalf of the Respondent. <br />4. 1 am aware that there areignificant penalties for submitting false information, including the <br />possibility of a fine and'enprisonment for known violations. (H 125191) <br />Title: J10 K <br />Signature: r <br />Date: <br />'EHD 22-02-005 Rev 10109 <br />