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06/30/2006 13:50 916353 75 NES PAGE 04/05 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 304 East Weber Avenue,3"Floor,Stockton,CA.95202-2708 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 web:www.sie v. r ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the "Notice to Comply"in the attached inspection report must be <br /> corrected within 30 d.ays of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD)address at the top of this form within 35 days of receipt of the <br /> inspection report. <br /> All corrections to other violations noted in the attached inspection Report (IR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days <br /> unless otherwise specified in the IR. <br /> For this certification. t0 be completethe operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will betaken for each.violation <br /> • Copies of sample results/manifests/train.ing records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> AA <br /> Inspection.Date: if 1 Fly 20p(0 Inspected.By: <br /> Facility Address: 1932 1J, CL Pm4pa. bQ. EPA ID#: C4h ` 1?1 KP3 q-7.5 <br /> I. certify under penalty of law that: <br /> L I have corrected the violations specified,in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of comPfiance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate,and complete: <br /> Photos-Paperwork Y Statement <br /> 3, jam authorized to submit this certification on behalf of the Respondent. <br /> 4. I am.aware that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: d)4N COLC Title: Se�,i i o 12 F,445 SPwA4 S l <br /> Signature: Date: T z <br /> J 0®� <br /> L <br /> E[ID 22-02-005 Rev 1.2-04 <br />