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17./09/2012 12:24 2093344684 RECEIVED <br /> 002454, <br /> _SAN d NOV 0 9 2012 <br /> EM VIONMENTAL HEALTA bEPARTMENT <br /> 9?9? n. n,CA -3029 <br /> F :? .(209)4f 8-3424 Faac: 209) 33 ehd SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> .......................... .. . ....... ....:... HEALTH DEPARTMENT <br /> TO COMPLIANCE CERTIFICATION <br /> Any MINQR Violations noted in the ONotlmm to Co W In the attached inspection Report must be <br /> correct 'gorrect6d within 30 days of 6aceipt of this i n. This certification form must be submitIled to the <br /> EnVi ntal Hear Department(E D)address at the top of tWa form within 30 days of receipt of the i <br /> In ' n Report. j <br /> An corrections to other violgkM noted in fthme Inspection Report(IR)or Continuation Form, <br /> or <br /> disputes td-Any viol cls,are to be&ibmittedusi V thils ce ors and returned t6 5HO wM6 30 days <br /> unkm o ' e speoffiNd in the Insp action Repo I. <br /> We: All EHD staff time associf ted v4%h iling to comply by ft above noted dates will be <br /> billed at the curmnt houii f rain. <br /> i <br /> For this certification to e c • B � operator of the site must.include: ' <br /> . A err/docurnenfing c orrec# re. lops.-, taken or will be n for violation <br /> • <br /> Copies of sampler mart'# inn paperwork,arWor <br /> verifying corrections <br /> • O•:`rator°s cert bort <br /> Inspecdon l ,-- inspected lay:_J� <br /> Facility-'Add {�.)" l e EPA I <br /> ... 2- <br /> I certify under penalty.of lawlthat <br /> 1, 1.have conWed tate violatlom.specified ir the f nspecffon Repod ftorp ft aboveqnerMoned <br /> inspection.date. <br /> 2. l have personalty examined ge following ikwumentation submitW as proof of c ompTranoe FOR <br /> EACH\110LAMON and I W16ve the- atiorrto tie true, ,and compleW. <br /> Pvtos pe rk <br /> Statement <br /> ; <br /> 3. 1 am authorized to submit this certification on behaff of the Respondent <br /> 4 1 am aware that there are sig ' pen for su !/ting Was informabon, including the <br /> possi '- of a fine and/or 1 f r Aolations. (HSC 25191) { <br /> Name: i+'� - T"rbe: <br /> Sign: re: Date- <br />