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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue,3`d Floor,Stockton,CA 95202-2708 Telep one: (209)468-3420 Fax:(209)468-3433 Web:www.sj og v.org RE TU TO COMPLIANCE CERTIFICATION Any MINOR violations not d in the "Notice to Comply" in the attached inspection report must be corrected within 30 days of eceipt of this inspection. This certification form must be submitted to the Environmental Health Depa ment (EHD) address at the top of this form within 35 days of receipt of the inspection report. All corrections to other viol tions noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, a e to be submitted using this certification and returned to EHD within 60 days unless otherwise specified i the IR. For this CertlfiCat1 n t0 be Complete the operator of the site must include: • A statement docum nting what corrective actions were taken or will be taken for each violation • Copies of sample re ults/manifests/training records/other appropriate paperwork, and/or photos verifying correction • Operator's certificat on Inspection Date: Inspected By: Facility Address: EPA ID#: I certify under penalty o law that: 1. I have corrected the iolations specified in the Inspection Report from the above-mentioned inspection date. 2. I have personally ex ined 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. lam authorized to su mit this certification on behalf of the Respondent. 4. I am aware that there are significant penalties for submitting false information, including the possibility of a fine aid/or imprisonment for known violations. (HSC 25191) Name: L— ��d 7_7 Title: Z14WI 4�- Signature: Date: c, EHD 22-02-005 Rev 12-04