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Oct 21 09 03:11p Francene Escobar 2098254539 p.1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone. (209) 468-3420 Fax:(209)468-3433 Web:www sig0v.crg/ehd <br /> RETURN TO COMPLIANCE CE d ATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached lnspe%: �epooI Lust be <br /> corrected within 30 days of receipt of this inspection. This certification form rNu t e submitted to the <br /> Environmental Health Department (EHD) address at the top of this form within 38' pflteipt of the <br /> inspection Report. `�`ENvay,.Nir AaTTAt <br /> t4eww D rdENT <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 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate of$105 (beginning 8/1/09 the hourly rate will be $115). <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 resuitslmanifeststtraining recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspected B ^. !1 t) I '^ l <br /> Inspection Date: P Y j "' <br /> Facility Address: —70'7 1 'I "`^'dX EPA ID#:eQ L pc�l 7_4 ro Zt0'Z _ <br /> ,p1 Q`Ti C A- ct��;3� <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. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. lam aware that there are significant penalties for submitting false information, including the <br /> passibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: Tit]e: <br /> Signatu . <br /> EMU 22-02-005 Rev 0"9 <br />