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O\ <br /> SAN JOAQu|mCOUNTY RECEIVED <br /> ENV|RONMENTALHEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stonkton, California 95205'6232 JUN /O�d <br /> Telephone: (2OQ)4G8'3420Fax:(2VQ)4O8'3433VKeb: � - --' ' <br /> ENNRONKXENT4LHEALTH <br /> -----PERNY/778ERVICEG <br /> ����FKU���� l��� COMPLIANCE �����7�U�U���l[U���� <br /> RETURN~°,�.� . ~~ ~,=~.°.. ~_.��.~~°~_ CERTIFICATION <br /> ,, .~~�� . ,~~.. <br /> Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days ofreceipt ofthis inspection. This certification form must besubmitted tothe <br /> Environmental Health Departnnent (EHO) address atthe top ufthis form within 30 days of receipt of the <br /> Inspection Report. HSC 25404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report (|R) or Continuation Fonn, or <br /> disputes to any violations, are to be nubnnbbad using this certification and returned to EHO within 30 days <br /> unless otherwise specified inthe Inspection Report. HSC 25185(c)(3) <br /> Note: All EH[} staff time mseocli.atcd w.thfai��z� �� ��m�!y �yth� ��o�� ����dA U-1aALVGX wil'iKbG <br /> billed at the current hourly rate. <br /> For this certification to be compfe+e theoporotorofthe site must include-. <br /> ° A utah*nnant 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 /> varifvingoornactionu <br /> ° Operator's certification <br /> Inspection Date: May 19, 2014 Inspected By:-Stacy Rivera <br /> Facility Address:8115 S. El Dorado St. EPA ID#: CAL000312367 <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,77�nd complete: <br /> Photos Paperwork L' 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 /> e*ouu'o2-oosRev ow1a1u <br />