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SAN JOAQUIN COUNTY 0 1 <br /> E <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 * <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.sj ov. <br /> MAY 262011 <br /> BAN JOAOULV COUNT,, <br /> RETURN TO COMPLIANCE CERTIFICATION1AR0Nk;ENTA_ <br /> ._-i=TH DEPAfiT,V.ENT <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 35 days of receipt of the <br /> Inspection Report. <br /> Allcorrectionsto other violations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> disputes to any vio a us,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 billed at <br /> the current hourly rate ($122). <br /> FOT >�]1S C01111Cat1011 t0 UE COIll�)etC the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will betaken for each violation <br /> • CoQies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> venfying corrections <br /> • Operator's certification <br /> Inspection Date: May 26, 2011 Inspected By: Aris Cacapit <br /> Facility Address: 200 Commerce St #101 EPA ID#: applied for <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I 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. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I 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: 7. r3sr, 64 &0 Title: (9 2 <br /> Signature: Date: _ Ztp—Zol <br /> EHD 22-02-005 Rev 08/10 <br /> eve � P�� f <br /> e �N� <br /> © c L4 <br /> A <br /> M>� -- w-�'Tek r-1CJ A A S T �-c t7 a r r✓ <br /> pT-S, <br /> 60 63 r- ;2aep /'Al. >✓cEtPFS . <br />