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06130:`2010 11:36 209-833-1e02 TRA01" P01.JER EnUIP P_`GE 02104 <br />SAN JOAQUIN COUNTY y �d <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www,sjgov.om/ehd JUN 3 © 1.010 <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 30 days of receipt of the <br />Inspection Report. <br />AL� corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />Jisp„ates 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 />doff=: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate, <br />'7 this Certification t0 be complete the operator of the site must include: <br />m A statement documenting what corrective actions were taken or will be taken for each violation <br />T Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />m Operator's certification <br />inspection Date:,L � � � � � Llpl)� _ Inspected By: fn�n�&A <br />`acb lity ,Address: 751 S GG; EPA ID#dPtL 006 7,659 0 <br />certify under penalty of law that: <br />t . I I12ve corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />have personally examined the following documentation submitted as proof of compliance FOR <br />EA':H VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos Paperwork Statement <br />I am authorized to submit this certification on behalf of the Respondent. <br />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 />I` IamE�: a Title` yS <br />:;i ionajtl.. <br />El IT;!2-o2.305 RE -v 10/09 <br />Date: ( , ]�.,[- ( 6 <br />