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0 SAN JOAQUIN COUNTY 9 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />N:11 till I Z4 9 1 a I " * j: <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 anyviolations, 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 bu <br />billed at the current hourly rate. <br />For, this certification to be completethe operator of t ' he 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 />1a03= <br />F;rM=,r,= <br />Inspected By: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />EHD 22-02-005 Rev 10/09 <br />I a W Z 0 1 0 -0 oil <br />Photos Paperwork Statement <br />!11!!!'� r lil•l I <br />"M <br />0 <br />