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Sep 18 12 03:36p Pro Lube 12095443637 p.1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, California 95205-6232 c G <br /> Telephone: (209)468-3420 Fax: (209)468-3433 Web:www.sigov.org/ehdr <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 H aafth Department (EHD) address at the top of this 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 (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. HSC 25185(c)(3) <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. <br /> For this certification to be complete the operator of the she must include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation <br /> • Copies of s mple results/manifests/training recordsiother appropriate paperwork, and/or photos <br /> verifying cor ections <br /> • Operator's certification <br /> Inspection Date: Inspected By: A+.)Sza- <br /> Facility Address, 9/,19 S , ,/' p_P7 LA. EPA ID#:_Cf 414) 0 Z4 73ki. <br /> z6A- 57- c? <br /> I certify unde penalty of law that: <br /> 1. 1 have coi rected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have pe sonally examined the following documentation submitted as proof of compliance FOR <br /> EACH VI LATION and I believe the information to be true, accurate, and complete: <br /> / Pa <br /> Photos 1perwork 9furStatement <br /> 3. 1 am auth)rized to submit this certification on behalf of the Respondent. <br /> 4. 1 am awa a that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (NSC 25191) <br /> Name: Title: <br /> Signatu -- Date: <br /> EHD 22-02-005 Rev 4i12 <br />