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j SAN JOAQUIN COUNTY <br />EwRONMENTAL MALTH DEPARTMENT <br />600 E. MWn St, Stockton, CA 95202-3029 <br />j <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www .aisav ornlehd <br />rVRN TO <br />COMPLUNCE <br />CERTIFICATION O <br />1 11 •° •i•1 P.• 1 the"Notice toComply" 7 the, 5 f9 V fInspection Report mustbe <br />4i • , : ! 1 ` • : !tempt ofthisf r ' AI i 1 This certification ♦ •1 i.♦ besubmitted to the <br />Y t 1 i¢Y. f W: ' i :+ iN. i1.�' address : the r r this within ♦ i Y receipt ofthe <br />All correcti6ps to other violations noted in the attached Inspection Report or Con inuatioa Form, or <br />disputes to any violatior s, are to be submitted using this certification and returned to EHD within 30 dans <br />unless otherR+'so specie in the Inspection Report. <br />Note: All W <br />, staff d ne associated with failing to comply by the above noted dates will be billed at <br />the current*ourly rab W <br />I <br />For this-,pertifia tion to be complete the operator of the site must include: <br />• A statement docimenting what corrective actions were taken or will be taken for each violation <br />• Copies of satrap results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corree 'ons <br />• operator's certi.ication <br />Inspection',: <br />Facility o'rress: ! • i &A 1,000 -351"I <br />I certify, under pon?'ty of law that: <br />t.:.-�e conveW the i :. i. f. i'specified 1 the Inspection ":," ! i • 1 the ► • : :I i • V " t <br />,don date. <br />2. <br />1 :. V - ' F f : - ii ! ' J. 1 _ • • +. i 1 ♦ 11 i..: i i. 1. ! 11. vU s Ya i • i t ; - �. <br />PhotosEACH VIOLATION and I believe the inforInation to be tue, accurate, and complete: <br />ray. <br />am' authorizelsubmit on behalf of the Respondentl, <br />4. ftclull the <br />possibilityof : ♦ f `and/orTimpfisomnwt♦ knownviolations.•' <br />ii I1,. J l j r 1 j' %r►t u' <br />i�nattixe: Date: Io - 3 • I t <br />EHD 22-02=605 Rev 1 <br />910/910'd 6096 968 60Z : XV9 9069#SAO Yid L 1:50 QUA 1102 -LO -M <br />