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SAN JOA UI COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East in Street, Stockton, CA 95202-3029 <br />Telep',,ona: (209) 468-3420 Fax: (209) 468-3433 Web:www.sjgoy.o[g/ehd <br />•IN <br />Any MINOR violations noted in the "Notice to Comply" in the attached Inspection Report must be <br />corrected within 30 days 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 30 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 />and returned to EHD within=1 •s <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <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 records/other appropriate paperwork, and/or photos <br />verifying corrections <br />Inspected By: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspection date. <br />ZRIZIM <br />0= <br />EHD 22-02-005 Rev 08/08 <br />Photos Paperwork Statement <br />rriiimrrl may-ritypumEE��--rm <br />Wo =64- <br />q <br />Title: <br />M0 <br />