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MAY-,9-2011 15:20 FROM: TO:id662271742 P.5�11 <br /> SAN JOAQUIN COUNTY <br /> ENV IRONMHNTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202.3029 <br /> ralephone:(209)468-3420 Far:(209)46&3433 Web:www_jiSgv.orpL <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 35 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,arc to be submitted using this certi creation and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with falling to comply by the above noted dates will be billed at <br /> the current hourly rate($122). <br /> For this certification to be complete the operator of the site most 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; 45/9// l Inspected By: Stacy Rivera <br /> _:7os Com. Cif .4 QJl <br /> Facility Address: EPA ID#CAR Opd I4`ild <br /> I certify under penalty of taw that•. <br /> 1. I have corrected the violations speci fled 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,accurate,and complete: <br /> Photos A Paperwork j _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: J����.a�rd3 _—TitleC. <br /> Signature, �+ Date: (oZ3/// <br /> EHD 22.02-005 Rev 08110 <br />