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Apr 18 12 02:20p Dave Field 916-991-3299 p.1 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street. Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www_siQov.orc ehdAPR 18 <br /> ..--.-._- 1.. <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations notDd 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 30 days of receipt of the <br /> Inspection Report. HSC 5404.1.2(c)(1) <br /> All corrections to other violations noted in the attached Inspection Report (I R) 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 site must include: <br /> • A statement docume ting 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: f Z Inspected By: 0 X64 Gy£Irl <br /> Facility Address: Z 3j t' aV erv'06 Irk' EPA IM: L'-iL, Ooo 3 (a'(- <br /> certify under penaI4,of law that: <br /> 1. 1 have corrected tie 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 VIOLATIO q and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 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 fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: r•1�j�LO Title:_ wAJ �- <br /> Signature: Date: q /I? / Z <br /> FH D"-W-005 Rene 09111 <br />