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.002454 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT RECEIVED <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telepsone:(209)468-3420 Fax:(209)468-3433 Web:www.siggy.org/ehd JAN 11 2011 <br /> OW*NMENTAL HF-4LT4 <br /> PERWT,"SERVICES <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 /> 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 EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <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 completethe 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, Inspected By: CACARI <br /> V®e-rloA— 12o.49 <br /> Facility Address: 9S'2 V0 EPA ID#: 64,096 t1,I�Y(5 <br /> _,go i eA. Z9 <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. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe theI�information,to be true, accurate, and complete: <br /> Photos !!I_Paperwork 64- Statement <br /> 3. 1 am authorized to submit this certification on be half of the Respondent. <br /> 4 1 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 /> Name: ^j (2�12po,<AO'CA,, Title: 7`74flg1010j,45-CeL_ <br /> Signature. 12 ....Date- <br /> EHD 22-02-008 Rev 08106 <br />