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Apr 07 09 09:33a 209- 67-5424 p.2 <br /> , <br /> ' SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone.(209)468-3420 Fax:(209)468-3433 Web:www.siaov.or /c/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <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(END) 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(1R) or Continuation Form, or <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 <br /> billed at the current hourly rate. <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 resultslmanifestsltraining recordsiother appropriate paperwork, and/.or photos <br /> verifying corrections <br /> • <br /> Operator's certification <br /> Inspection Date: C�o Colzoacy Inspected : = <br /> UWWG- <br /> 44ft <br /> Facility Address: SysaCA EPA I <br /> I certify under penalty of law that: - <br /> 1. 1 have corrected the violations specked in the Inspection Report from the ab®ve-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and 1 believe the information-to be true, accurate, and complete, <br /> Photos Paperwork Statement <br /> 3. lame authorized to submit this certification on behalf of the Respondent. <br /> 4. 1 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 25991) <br /> Name: Title: 61.049M <br /> Signature. Date: <br /> EHD 22.02-005 Rev 08108 <br />