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-7� <br />SAN JOAQUIN COUNTY <br />F,NV1R0NMENTAL HF,A[,TFI DFPARTMEN'I' <br />Goo Earl Mein Street Stockton, CA 95202-3029 l+Vll <br />Telephone: (209) 468-342.0 Fax. (209) 468-3433 Web: www.sjggv.or � chiI �,+dCl I o4 I YGtYI DViNc,l <br />RETURN TO COMPLIANCE CER'T'IFICATION <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 Dorm must be submitted to the <br />Environmental Health Department (FHD) 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 E.EiD within 60 days <br />unless otherwise specified in the IR. „ -i. <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 betaken 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:_ Inspected By:_W_d.i„j__N_ <br />Facility Address: ; at w..Cha rtw Wil EI11)A. ID <br />( h) * tMl , 0/4 9 � <br />I certify under penalty of law that: <br />I . 1 have corrected the violations specified 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 Paperwork ',6 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 251.91) <br />Nzm�{!1_6 ic: ,Ef GT% Title:----. I�'�t0�� !l , <br />i <br />Signature: Date: <br />dr <br />F.T-M 7.7.-07.-005 Rev 05/07 <br />2T d w2a : Lo Loaf of ' Unf vgvoEgb60z : ' ON XHJ H I NZ10J I -1d0 J0 i-1 : W0�1J <br />