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RECENED <br /> Kip 14 <br /> -401W <br /> SAN.IOAQUiN COUNTY ENV,{� •��mbw 11�/tA,--�Ty <br /> ENVIRO'�lMENTAL HEALT}t DEp.A PTMENT � ''- " r1 )MV-,I 1 <br /> 600 East Main Street,Stockton.CA 9-)'02-3029 <br /> Telephone.(209)468.3420 Fax:(209)468-3433 TVA. www,siuov_org/ehd <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, are to be submitted using this certification and returned to EHD within 30 da-ts <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 /> For this certification to be complete the operator of the 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 /> Inspection Date: August 17, 2010 Inspected By: Garrett Backus <br /> Facility Address: 6131 _Pacific Ave EPA ID#: 6R1-O DD .3 4ko 6A e <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspectior 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,X_,__Paperwork Statement <br /> 1 I 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 irnprisotunent for known violations. (HSC 2519 1) <br /> Name: HUAA; 'T7'-11-WH 2?' A 1-1 Title: Q WI,Gt< <br /> Signatur <br /> EHD 22-02-005 Rev 08/10 <br />