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2010=08-12 11 ;48 >> 2094683433 R 1/3 <br /> SAN JOAQVIN.COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 E.Main St;Stockton;C.4;95202-3029 <br /> Telep"A' (209)468-3420 Fax:(209).468=3433 Web:yny .. r:or6phd <br /> RETURN TQ COMPLIANCE CERTIFICATION <br /> Ally MINOR violations noted in the-Notice to Com <br /> ply'°in the attached Inspectl9 eport must be <br /> �r acted within 30-dans of receipt of this inspectio .- tits certification form tus be'Vubmitted to the <br /> Eztviionuiental:.Healtlt Depazrtmen#(EHL))address a er this farm v h receipt the <br /> Inspection Report. ;; _ �s of recei <br /> All.Corr ctio s to Cher ViOWons noted in the attached InspecAw*bja 1Coatinuation.Form,or <br /> disp.Utes:to any violations,are to be submitted using this certifxcatiou and returned'to EHI? thi 30 <br /> unless otherwise spec$ed.ill the Inspection Report. sqN JOn, ,;�;ci, NTl y <br /> Note: All'EHD staff time associated with fa ifln to compc���o*�A°�r.=��� <br /> the current hourly rate($122), gtloted dates'will be billed at <br /> For this Certification to be Complete the operator of the.site must include: <br /> • A statement documenting what corrective actions were taken or wiiI be taken for each violation <br /> Copies:of sample results/manifests/training records/other appropriate paper�vorl ,and/or photos <br /> verifying corrections <br /> Operator's certification <br /> Inspection Dat <br /> P e Inspected By: <br /> f <br /> Facility Address: Lro�,l t d1j CAi�/74,1, C14 EPA ZD# <br /> I certify undor <br /> Penalty of law that, <br /> 1. I have.Corrected the Violations specified in the Inspection.Report f'om,the above-mentionP,�. <br /> ihspection date. . <br /> 2. I have personally exam ned,the followingdocumentation submitted as proof of compliance:FOR <br /> EACH VIC?LA?ZON and I believe the information to be.true,accurate, and,camplete: <br /> Photos X_Papenvork Statement <br /> 3. .I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I arta aware that there are significant penalties for submitting false information, including'tlre <br /> Possibility of a fine and/or imprisoanment for known violations. (HSC.25191) <br /> Nam. e � , F <br /> Title: z.��,f7��i✓a�v< S <br /> =Signat �,i D <br /> ate <br /> EHD 22-02-005 Rev 08/10 <br />