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SAN W:. i. <br />P, <br />ENVIRONMENTAL HtAum DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />AUG 12 ZM#ephone: (209) 468-3420 Fax. (209) 468-3433 Web - www.sigov.orcitehd <br />9,115"MMMUNto r <br />HEALM 0jS-",A31'iV'ENT <br />RETURN TO COMPLIANtt ttRtWICATION <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 ($105). <br />For this certification to beCOMPIeoperator of the site must include: <br />• A statement documenting what corrective actions were taken or" be taken for each Violation <br />• Copies of sample results/manifests/training records/other paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: Z4�_Iop <br />Facility <br />SrVd/4,44� jPSoj.0j& <br />I certify under penalty of law that: <br />Inspected By:, A 1W44v_e_,j M_ <br />- Z ----------- -1111111111111111111111111 <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 theinformation to be true, accurate, and complete: <br />Photos _���w6fk X 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: XpkeALT or -:.-44 k till o' Title: <br />.0c - <br />re: <br />EHD 22-02-W5 Rev 08/08 <br />LIMM <br />