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.�•r:y'.' ,�'"o"� '/,,*�cy� .tet+,. '+,rw:4.Nf ��"" t'M'' `guy.;^+. „T!'e+—•L'Y'*.m'. G--�",Y!.J `""'.,, �:s+t :!F�s Ar 'AN Rf,�xwe•r`+`-.. •r'M1.'K.r�'y„'"•. ,.", .,� . , .,+Tt w <br />� <br />�� <br />SAN JOAQUIN COUNTY LE�Il'I�JL��D <br />ENVIRONMENTAL HEALTH DEPARTMENT VV <br />600 East Main Street, Stockton, CA 95202-3029 Nrl'l y U 7 cuia <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.-' / hr1 <br />77 PE��,trr� T. HFALT4I <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 30 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 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. <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 <br />• Operator's certification <br />Inspection Date: 44/Wlb0 Inspected By: <br />Facility Address: Z�jcj h,7c, r. d —,61L Cies te— EPA ID#: <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 IIbbelieve the information to be true, accurate, and complete: <br />✓ Photos VmaPaperwork V Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 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:ff/by ArGy *&� Title: Sawn �"/�%A <br />Signature: <br />EHD 22-02-005 Rev 10/09 <br />Date: 5 /.�7-//o <br />