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0 SAN JOAQUIN COUNTY 0 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />j2ba6,#,, - I• . , �, , , 11'�•1 1, <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 (EHD) address at the top of this form within 30 days of receipt of th,; <br />Inspection Report. <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 bZ <br />billed at the current hourly rate. <br />For this certification to be completethe 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/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />3KPI SIM UOT&WTA fi UiFl <br />IIITTITTZ• �. <br />404 111 ZTj ff .7—= <br />Inspected By: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentionet <br />inspection date._ <br />Dues11411cit- <br />i] Is <br />:Ihotos Paperwork Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />ILgrp] Niglio Now - <br />9= <br />EHD 22-02-005 Rev 08/08 <br />Im- <br />am <br />