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E�1!05,. 26766 05:5� 503524" 9 RUTH HA - BP PAGE 61/61 <br /> SAN JOAQUN CC)LWrV <br /> ENVIRONMENTAL REALTH DEPAkTMENT �l <br /> 600 E.Main St,Stockton.CA 95202-3029 <br /> Telephone:(209)468-3420 Fax(209)468-3433 Web =ML. jMv,or¢/ehd <br /> RETTJMR,N TO COMPLIANCE CERTIFICATION <br /> Any MINQR 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 certificaticni form trust he submitted to the <br /> Environmental,1-lealth Department(ERD)address at Lite top of this.forth within 35 days of receipt of the <br /> Inspection.Report. <br /> /all cotzcctions to other vioiations noted in the attached Inspection.Report or Continuation Form, or <br /> disputes to any violati[ms,are to be submitted using this certification and returned to EHD w t 'p.30 days <br /> unless otherwise specified in the inspection Report. <br /> Note: A,II.E.1FiC.D staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate(s98). <br /> For this certification to be COMPIeW the operator of the site must include: <br /> * .A, statement documenting what corrective actions were taken or will betaken:For each violation <br /> * Copiers of sample:results/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying con-ections <br /> Operator's certification <br /> Inspection Date: l�� j�,�(� Inspected.By: <br /> Facility Address: EPA ID#: C'V <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. l have personally examined the following documentation.submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate,and complete: <br /> Photos ig, Papem,ork St;;.tement <br /> 3. 1 am sutborized to submit this certification on behalf of the,Respondent. <br /> 4. Jam aware that there are significKtrtt penalties for submitting Use information, including she <br /> possibility of a fide and/or imprisonment for known violations.(HSC 25191) <br /> 61 <br /> Name: (•��� <br /> Title: <br /> Si,guature, f r'�'-' <br /> date: <br /> END 22-02-005 Rev 10-07 <br />