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SAN JOAQUIN COUr1TY <br /> \'+�ENVIRONMENTAL HEALTH 0EPARTMENI T <br /> 60()' aKt fr4siil StNQt, Stockton.CA$5202-3029 <br /> T*jt. anx t209j 468-3420 Fax:(209)43$-3433 Web L^r:.Yt3.�3WV c* �qbtd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any rMIld C?'r2 violations noted :n the"Notice to Comply' in the atta- chtad inspection Report must be <br /> Correctad.rein 3�days o`racers ref ti,is ins�c tion_ This cert�c atio;I form must t rr suAnjit ed to ttte <br /> nvkonmc�ntal Health iJapartrneinf t NL)) address at tile.top of ttlis Corm, within 30 days of receipt o:the <br /> insnoctiwn Report <br /> All c(XYe-tt 1 t 2th r vPglat!pn;i tinted in the attached Insl-sec#ion Re1'ar)rt (JR)or clontinuation Form, or <br /> cisputexs,to any violations, are to r`:*submitted usmq- this c;erti ivation and returr. cl to E40 <br /> unless,other-rise Specified in the lnspoction Report <br /> - <br /> :at It EHD staff time a oci t4.+tj with tailing to c€ rnpiv b, the above noted dates will be <br /> milled at the ctj"ont hoitirly ret. <br /> For this certification to be CoMpleAE4 the o;mrator of the Rite imtlst <br /> A statement durumenting.-mat currect ve action=ewe iaken or Aflj be takctn for each viol.)tjon <br /> . Cop es of sample resultsim.aniFe3is/training re cordslother.appi,op icilta µ3p$rovtarl: ar;�JJor Photosverifying lorre;;tions <br /> O rator s certification <br /> ! P � <br /> ( InspectJon Date'_. ' - ) t_� -- inspected By-_ <br /> j <br /> Facility rittr ss: j u-vI -t►.. _ EPA ;-04: C. R(-rL CX3 1 <br /> ` i; 14(=) <br /> I I Certify undut penpliy of lav Piet. <br /> 1 i have,corrected the vio!alions specified in the Inspection R!:)poil frorn the above-rrm,,mtio,^tom <br /> inspection date <br /> 2 i have personalty examined t1he foilowing documentation Submitted as prow of corrtta'iance FOR <br /> EACH VIOLATION and I believe the information to be true. accurate, and complete: <br /> Rlacato —Papen-sorts __,_ tati:rrti nt <br /> 3 I air, au#hCsrYzR:j to sUtv~nit this iycartitrc soon on b:half of Ole Respondent <br /> 4 i am aware that there are si ni:icarn � <br /> g penalties for stst3rni##irq false information, including tine <br /> Possibility of a fine andior irmprisonmant for known violations. (t-tSC 25191 i <br /> e4aN`j` _. i itie.j ? r- <br /> 8ignati,ir; �� - bate y - � <br /> R1 E <br /> r �.,.. ... AUG 3 0 2011 <br /> SAN JOr';U�i.i COUNTY <br /> ENWROP MON SAL <br /> HEALTH DEPARTMENT <br />