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SAN JOAQUIN COUNTY g <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephoner(209)468-3420 Fax:(209)468-3433 Web.u -w.sie y.ore%hd <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(IR) or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days <br /> unless otherwise specified in the IR. <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 IL <br /> • Operator's certification fV� t <br /> Z L A_9 <br /> Inspection Date: 510-7- Inspected By: roUA 'YW <br /> ,i$5i . Sr' PET q <br /> Facility Address:,4,S,04 70 Irl CA 6K;_24 EPA ID#: UKL 00 D <br /> I certify under penalty of law that: <br /> 1. 1 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 compliance FOR <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. (HSC 25191) <br /> Name:_ -Title: )w�y.e K- <br /> Signature: i Date: A �� <br /> t�- <br /> Fxn��_n�_nns <br /> Raw 05/m <br /> 60170 39dd SEE9 00ad sdsadn n 8L086b6607 L7 :7t Lee7/s7/tt <br />