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9- 8-08; 4:31PM;YELLOW ;913 344 4676 # 1/ 4 <br />SAN JOAQUIN COUNTY <br />ENV IRONMENTAL HEALTH DEPARTMENT <br />304 East Weber Avenue, Yd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjeov.org/ehd <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 to be complete tete 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 <br />• Operator's certification <br />Inspection Date: 6 -(917 — y i, Inspected By: W; �); e N q <br />Facility Address: 1SK E • Pes 4rC 'o /-tve_. EPA ID#: CAI. 00 C) 03�' R6, <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. I 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 />P� Ioe ties Ie lTitle: S^,?te�'V 15 o r -�.I <br />re:�+ f � S2w; cES <br />w12"�5 Date: <br />EHD 22-02-005 Rev 12-04 <br />