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03/28/2008 13:07 2094732344 MARCH LANE 76 PGE 01/01 <br /> SAN JOAQWN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT RAR 2 <br /> 600 East.Main Strect, Stockton,CA 95202-3029 82008 <br /> Telephone:(209)469-3420 F&r-(209)468-3433 Web:-W.-W, Wsigov.orj�—ehd SAiVJ0AQUjtVCOO ME Q N <br /> rA A <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR,violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected w' ithin 36 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 /> All corrections to other violation a noted in,the attached Inspection Report(IR)or Continuition 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'lvill be billed at <br /> the current hourly rate ($98). <br /> For this certification to be complete the operator of the site must include: <br /> 0 A statement documenting what corrective actions were taken,or will. be taken for --ach violation <br /> 0 Copies of sample results/manifcsts/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> cri <br /> Operator's certification <br /> Inspection Date: 0 Inspected By: <br /> 'rL 1 jq!-2W14 <br /> Facilfty.Address: d,701 VJ, N\A �-AOeEPA [D#: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mcntioned <br /> inspection date. <br /> 2. 1 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 compli-.te: <br /> Photos Paperwork Statement <br /> 3. 1 am 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 25191) <br /> Name: 0 rA.3 5001, Title: <br /> Signature: Date: 0 �S <br /> EHD 22-02-005 Rev 11/07 <br />