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Jan 07 08 11 : 26a Stan Morri Ford-Mercury 2098892519 p. l \� <br /> FRECOVED <br /> SAN JOAQUIN COUNTY ylt;rl Q 7 2008 <br /> ENV[RONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 Cn�VIRUVMENT HEALTH <br /> Telephone: (209)468-3420 Fax:(209)468-3433 Web:www.siQov.orp/ANVIR , MENT HEAL <br /> A� <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 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($98). <br /> For this certification t0 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/mariifests/training records/other appropriate paperwork,and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> ® <br /> Inspection Date:�� Inspected By: � ' <br /> Facility Address:-:155-00 �4d�c �'�u u,r-,�«.� EPA ID#: LAG 0L'C b <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 X 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: 41 �1X411 Title: 14%k <br /> Signature: _` Date: <br /> RRT)22-02-Q05 Rev 11/0— _ _ <br />