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09/01/2004 15:32 20946 3 FIFTH FLOOR PAGE 03 <br /> RAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br /> EWIRONMENTAL HEALTH DEPARTMENT � <br /> 304 E. WEBER AVENUE <br /> •STOCKTON,CA 95202 <br /> CERTIFICATION OF RETURN T4 COMPLIANCE <br /> For Hazardous Waste Generators <br /> In the matter of the Violation cited on: <br /> As Identified in the Inspection Report dated® ilylm <br /> Conducted by: _ �+4 I W,% [EHD Inspector(s)] <br /> I certify under penalty of law that: <br /> 1. Respondent has corrected the violations specified in the notice of <br /> violation cited above. <br /> 2. 1 have personally examined any documentation attached to the <br /> certification to establish that the violations have been corrected. <br /> 3. Based on my examination of the attached doau entatlon and <br /> Inquiry of the individuals who prepared or obtained it, I believe that <br /> the Information is true, accurate,and complete. <br /> 4. 1 am authorized to file this certification an behalf of the Respondent. <br /> 5. 1 am aware that there are significant penalties for submitting false <br /> information, including the passibility of fine and imprisonmentfor <br /> knowing violations. <br /> t,", <br /> Facility Address EPA ID. Number <br /> Name (Print or ype) Title <br /> Signature Date S ned <br /> EMOCERT(rev 1107102) <br />