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OS VAY. 9.2005.-2412:-41PI!209858.91.i,$O SWIFT SHOP LATHROP NO.942 P.3 <br />9004/0 <br />SAN JOAQUMCOUM <br />EXVIRONMENTAL HEALTH MPAPUMM <br />304 East Wcbff Aymue, 3W Floor, Stott CA 95202.2708 <br />T019kofic; (209) 468-342or= (209) 469-3433 Web: vMM4Vv.MaL <br />RETURN TO COMPLIANCE CER TMICATION <br />Any MW—ORviolations noted <br />in ' <br />Correctedwi - 30 the "Notice to COMMY"in thea inspection report must be <br />Of =*t Of this inspection, This certifications form must be submitted to the <br />InvIrOnInClItal Ileallb Depa=ent (F -FW) address at the tap Of this form within 35 days of receipt of the <br />All other <br />disputes to any violations, are ans noted in the attached Inspection Report (jR) or Continuation Form, or <br />to be submitted using this certification and returned to EjqD <br />unless otherwise specified in the I.R. within 60 days <br />For this certification to be complete the operator of the site must include:• ' <br />A statIment documenting what corrective actions were taken or will be taken for each violation <br />• Copies Of sample imsults/maniftts/training rwords/otherappropriate <br />verifying paperwork, and/or photos <br />verifying corrections <br />0 Operator's certification <br />Inspection Date: Inspected <br />Facility Address: Cko -r <br />EPA ID#: 0p, r -tho <br />I have corrected the violations specified in tbe, Inspection Report from the above-mentioned <br />inspection dge, <br />2- 1 have personally examined the following docmentation.submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />--Photos hwerwork -Statement <br />3. 1 mm authorized to submit this Certification on behalf of the Responderl <br />4. 1 am aware that there are significant pcn;ilties for submitting false iziformation, including the <br />possibility of a fine and/or iniprisonment for Imown violations, (HSC 25191) <br />e, <br />NameTitle: Se.!ZG(0_ <br />Signaturry,_\ Date: 9 <br />