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V 1 d 1a*n 0v\ # (O <br />lee-ar41,`S . I�-► CGi2 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL 14fAt.TFIDEPARTMEN1' Foi)iycl 1b rt°iz�Iv) b)j- l}C <br />600 East Maio Street, Stockton, CA 95202-3029 r, -q u t VCG{ 6cy t - f t Y Vi W T -a -,K <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sixgv.or&hd � <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 (1R) or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days <br />unless otherwise specified in the 1R. <br />-i- <br />For this Certtfi cation 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/manifests/iTaining records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date.:_ Inspected By: W ! I I U _ N GI `� <br />Facility Address: 1WN EVA. ID#: -1,A -TODD gdZ7��1� <br />�S�Oc,1�ta ( 0 A C1 SaC) �o <br />I certify under penalty of law that: <br />1. 1 have collected 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 X Statement <br />V 101(/i <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. T 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 2519 1) <br />Name:i((d2C1Q ChYl6-�lQvi O I'itle:_t�f1 i VDI/1 ✓YIC,K > Gtl �_ SGt StSt <br />_,l <br />Date: � II b 2flo % <br />Signature: em w( i� 1'Yt � ... ---L-- <br />FTM 7.7.-07.-005 Rev 05/07 <br />RZd WH20 : Z0 ZOOE OE -u"f b9b0Z9b60E : 'ON XUJ H I N�JOA I HD A0 1-10H : WO�JA <br />