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' 4 <br /> i <br /> d <br /> SAN JOAQUIN COUNTY <br /> ENvjRoNmEbrrAL HEALTH DEPARTmENT <br /> 600 East Main Street,Stockkni,CA 95202-3029 <br /> T hones(209)468-3420 Fara(209) 3433 Web: .sj ov. ehd <br /> i <br /> I <br /> RETURNTO COMYLLANCE CERT CATION <br /> i <br /> Any MINDR violations noted in the"Notice to Comply"in the attached inspection Report must be <br /> MMM124 y ift 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 35 days of receipt of the ' <br /> Inspection Report <br /> s <br /> All connections to other.violations noted in the attached Inspection Report(IR)or Continuation Form,or 1 <br /> disputes to any violations,are to be submitted using this certification and returned to EHD within 30 days <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 billed at <br /> the current hourly rate($122). <br /> For this certification t0 be complete the 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/ es other appropriate paperwork,and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: February 16, 2011 Inspected y: Garrett Backus <br /> f <br /> Facility Address: 3202 Hammer Lane EPA ID : CAL000338010 <br /> I <br /> I certify under penalty of law that: I <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. i <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate,and complete: <br /> Photos Yapetwork Statement �! <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that there are significant penalties for submitting false information,including the ( <br /> possibility of a fine and/or imprisonment for known violations.(HSC 2519 1) j <br /> Name: <br /> i <br /> Sign Date: <br /> EHD 22-02-005 Rev 08/10 <br /> i <br /> i <br />