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Dec 07 12 09: 29a 1r EA 's Ruto Care 209-83a-0300 p. 2 <br /> SAN JOAQUIN COUNTY <br /> ENvFRONMENTAL HEALTH DEPARTMENT <br /> 600 E.Main St.,Stockton,CA 95202-3029 <br /> ekephone:(209)468-3420 Fax.(209)468-3433 Web:www.sigov.org/ehd <br /> RE URN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violation noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30 da s of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Pepartment(EHD)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to otherl violations noted in the attached Inspection Report or Continuation Form,or <br /> disputes to any violatio s,are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise speci ed in the Inspection Report. <br /> Note: All EHD staff a associated with failing to comply by the above noted dates will be billed at <br /> the current hourly ra a($12U7. <br /> For this CertlfiC tion t0 be Complete the operator of the site must include: <br /> • A statement do umenting what corrective actions were taken or will be taken for each violation <br /> • Copies of sam a results/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying come tions <br /> • Operator's ce fication <br /> Inspection Date: t.t l Inspected By: <br /> Facility Address:2 C\ EPA ID#: <br /> `T o-o u) CA <br /> I certify under pen ty of law that: <br /> 1. I have correcte the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personall examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLA ION and I believe the information to be true,accurate,and complete: <br /> Photos Paperwork X Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 am aware that ere are significant penalties for submitting false information, including the <br /> possibility of a ne and/or imprisonment for known violations. (HSC 25191) <br /> Name: Title: <br /> Signature: Date: 1 <br /> EHD 22-02-005 Rev 08110 <br />