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m► <br /> SA.N JOAQUIN COUNTY <br /> EN VTRONMENI TAL HEALTH DEPARTMENT <br /> 304 Ecst:Weber Avenue,3`d Floor,Stockton,CA 95202-2108 <br /> 7etepone:(209)468-3420 Fare:(209)468-3433 �t'el�: wvv�x.:�' roy.or ells <br /> RETUt To COMPLIANCE CER.TIFIt:ATION <br /> Any M.T� )R violations no ed in.the"]notice to Comply"in the attached inspection report rn•ust be <br /> Any <br /> 0:0rxec��d jthin 30 dais o receipt o_'-this inspection. This certification Harm must be subrnitierl to the <br /> l✓nvironmerutaY Health I3 Wp (,.at(E;HD) address at the top of this firm Nvithin 35 da; s oI're�e Pt of the <br /> inspection report. <br /> ,�11 corrections to other vio ations noted in the attached Inspection Repoit(110 or C'ontirmation FC)nl'1„o--r <br /> disputes to any violations, e to be subrnitted using this certification.and re, <br /> turnecl to�'fID���itYrir� 6 }��ayt, <br /> jnie,&., ctherwise specificd n thE,M. <br /> For 'tis Cerifit;2.11 fl -to be completethe operator of the; site must include: <br /> • A. stateme:ni documenting v0dat conective actions were;taken or will be to -e.n for each violation <br /> • C.(jpi ;of s.n-.ple r Sults/mat ifests/training records/otlh:er approl►rirta �aper�n�rk, ;�cUor photos <br /> verifying correctio. s <br /> v Cq)erator's cer-tific-tion <br /> r ;; ? ► �•'�✓ Inspected Et��:��,�.��_� <br /> insp ction Date: — — — - <br /> Facility Address ,EPA ID#-_C &41 <br /> I rer.ify under taea.alty of lav✓that: <br /> 1. I have corrected th violations specified in the Inspection Report fent the above-mentioned <br /> i:nspec io-i date. <br /> proof of compliance F��>t. <br /> . I have pA. <br /> . sonal'.y arnined the following documentation subrn'V:ed a::. <br /> VIOLND N and I )elie:ve the information to be true, accuate, and cotnpl.ete: <br /> �� Photos aperwor�{�_�►iate, ient <br /> 3. I ani authorized to ubmit this certification on behalf of the Res.po�ident. <br /> 4. lam aware fl=at th. a are- sitmificant penalties for submitting false inf rmation, inc;_t:.ding the <br /> possibility of a fn and/or imprisonment for known violations. (:FISC 251! 1) <br /> t"�I�'� _ 'Tide- <br />