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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 952�02-3029 <br />11 1 11 . MOTIT.�4 1=1 0 1 A A alm"1164 a I 461111MA <br />.."s MMOKIN WORM, 0=4111MMOMMI W 111110111111 A I A -44 . WON .1. 11 1 111 <br />Inspection Report. HSC 25404.1.2(c)(1) <br />Note: All 1EHD staff time associated with ling to comply he above n ates w e <br />billed at the current hourly rate. <br />For this certification to be completethe operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample results/manifests/training recordslother appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: Inspected By: Stacy Rivera <br />Facility Address:/ � EPA ID#C�4 <br />_1 <br />CA- <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. 1 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 —.Zpaperwork—k—/Statement <br />W <br />EHD 22-02-M Rev 09141 <br />IN UNIT! 12112111M 1111;1 1 <br />IMWEU�� <br />