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FROM :-1 FAX NO. un. 04 2008 12:31PM P1 <br /> V <br /> RECEIVED <br /> -JUN U <br /> SAN JOAQUIN COUNTY <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL <br /> ENVIRONMENTAL HEALTH DEPAWI-MENT HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 F=(209)468-3433 Web. www.sj&q_v,org/e <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(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 billed at <br /> the current hourly rate($98). <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 /> e Operator's certification <br /> 199 hek CC T�_ <br /> Inspection Date: Inspected By: <br /> Facility Address: 515 k), /1 EPA ID#:- 6 A <br /> I certify under penalty of law that: <br /> 1. 11 have corrected the violations spccified in the Inspection Report from the above-mentiohe,iA <br /> inspection date. <br /> I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I be the informbebe true, accurate, and complete: — <br /> Av 6�- <br /> Photos Paperwork Statement <br /> _ j <br /> I am authorized to submit this certification on behalf of the Respondent. <br /> 0 <br /> ICA am aware that there are significant penalties for submitting false information, including the <br /> V possibility of a fine and/or impri(o-lonent for known violations. (HSC 25191)Name: <br /> Signature: Date: <br /> I-TTT'% n1% ^'% 9%1%C T2- 7 8/A7 <br />