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10/14/2009 15:49 FAX 12093650525 CHEROKEE SMOG AND REPAIR IA001/003 <br />SAN JOAQUIN COUNTY <br />dNVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone. (209) 468-3420 Faz: (209) 468-3433 Web: www v. <br />RETURN TO COMPLIANCE CERTIFICATION ?Xqa MEsT <br />Any MINA$ 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 />Envirdmnental Health Department (EHD) address at the top of this form within 35 days of receipt of the <br />Inspection Report. <br />All ' ns to other idolations 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 F, staff time associated with falling to comply by the above noted dates will be billed at <br />the current hourly rate. <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: Q Inspected By:A , C <br />f I <br />Facility Address: CJ4Ao �r� tvj EPA ID#:- CA -L CCV <br />1, cfc& C.W2 zea <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 tlii following doctfrrlentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos Paperwork 07� 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 />Natne;--�.K�; tW.4C4 V � Title: <br />EHD 22-02-005 Rev 11/07 <br />