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Cal-EPA DEPARTMENT OF TOXIC SUBSTANCES CONTROL GRAY DAVIS,Governor <br /> SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY �• <br /> '4;.••�w�ii hpP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> 304 E.WEBER AVENUE r <br /> STOCKTON,CA 95202 <br /> CSI IROTNp <br /> TIERED PERMITTING <br /> CERTIFICATION OF RETURN TO COMPLIANCE <br /> For Permit by Rule, Conditionally Authorized, and Conditionally Exempt <br /> Notifiers <br /> In the matter of the Violation cited on : <br /> Located at: (facility address) <br /> As Identified in the Inspection Report dated <br /> Conducted by : (agency(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. I 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 documentation and inquiry <br /> of the individuals who prepared or obtained it, I believe that the <br /> information is true, accurate, and complete. <br /> 4. I am authorized to file this certification on behalf of the Respondent. <br /> 5. I am aware that there are significant penalties for submitting false <br /> information, including the possibility of fine and imprisonment for <br /> knowing violations. <br /> Name (Print or Type) Title <br /> Signature Date Signed <br /> Company Name EPA-ID. Number <br /> Revised 3/5/02 <br />