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WWRM r. 31. 2008;i 9: 00 AM n: iS1024No. 3404 P. 10.1 <br />oQ <br />`� • • by <br />San JOAQUtN COUNTY <br />I;NVIRQNMwmHEALTH DEFARTMONT " <br />304 East Weber Avepue, 3`4 Floor, Stookm CA 95202-2708 <br />T&phone. (209) 468.3420 Far: (209) 468.3433 Web: www o kehd <br />ih•;' ,., .� - .a. a ._ jr <br />,Allions_to e _ er�±iolatians noted in the attached hmWtion Report (M) or Continuation Form, or <br />disputes to any violations, are to be submitted using this c4rtiiiicadon and returned to MM v, vi Q„dars <br />unless otherwise specified in the IR. <br />For this Certification to be Complete the operator of the site nmt include: <br />• A statruntat documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample results hnanifests/training records/other appropriate paperwo*, and/or photos <br />verifying corrections <br />® Operator's certification <br />Ins�eetion Date- Q1 QAg=- --- Inspected BY: 6&Nmft <br />1 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. I have personally examined the following documentation submitted as proof of caTnpliance FOR <br />EACH VIOLATION and I believe the information to bo true, accurate, and complete: <br />3. I am authori2ed to submit this certification on behalf of the Respondent, <br />4. I ern aware that there are significant penalties /for submitting false information, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name: —u A tJA A rJ•DkARAk;, P -P /V Title: HSI; sP64U1 ST <br />Ohl s e1'Wi/�, <br />RKn'.'.n7-nns Rp., t) -AA <br />