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SEP-16-2009 08:30 FROM: T 4178747102 P.3 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.siaov.oralehd RETURN TO COMPLIANCE CERTIFICATION Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be correct d within 30 clays of receipt of this inspection. This certification form must be submitted to the Environmental Health apartment (EHD) address at the top of this form within 30 days of receipt of the Inspection Report. All corrections to other violations noted in the attached Inspection Report(IR) or Continuation Form, or disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the Inspection Report. Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at the quirrent hourly rate of$105 (beginning 811109 the hourly rate will be $115). For this certification to be complete the operator of the site must include: • A statement docu enting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrects ns • Operator's certification Inspection Date: V - AS Inspected By: 7rZ f V4 0V F-G"L^ Facility Address: lvq w. L-;� k"rs�111v1 EPA ID#: I certify under penalty of law that: 1. 1 have correct d the violations specified in the Inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION and I believe the information to be true, accurate, and complete: Photos ✓ Paperwork / Statement 3. 1 am authorized to submit this certification on behalf of the Respondent. 4. 1 am aware that there are significant penalties for submitting false information, including the possibility of a fine and/or imprisonment for known violations. (HSC 25191) Name: Title: C/li�t►ti�N^^�^sn4c- Signature. Date: END 22.02-006 Rev 00109