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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgoy.o[g/ehd XETURN • COMPLIANCE CERTIFICATION Any MINOR Violations noted in the "Nd 6e to Comply" in the attached Inspection Report must be corrected within 30 days of recei p't of this inspection. This certification form must be submitted to the Environmental Health Department (EHD) address at the top of this form within 30 days of receipt of the Inspection `•• All corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or disputes to any violations, are to •- submitted using this cert' cation and returned to EHD within 30 • unless otherwise specified in the Inspection -••' • All EHD staff time associated with failing to comply • the above noted • will • billed at the current • rate. For. this certification to be completethe operator of the site must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos • corrections • Operator's certification Inspection Date:_1Z ej-Tc--- to Inspected By: IF icility Addressl:a(l -C-f ALGL EPA ID#: C re -n C S, 1 certify under penalty • law that: 1. 1 have corrected the violations specified in the Inspection Report from the -above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATI d 11,believe the inforlination VY true, accurate, and complete: 'Photos Paperwork Statement 3. 1 am authorized to • this certification on •- • the Respondent. 4. lam aware that there are significant penalties for submitting false information, including the' possibility of a fine and/or imprisonment for known violations. (HSC 25191) Name: ffo� EHD 22-02-006 Rev 10/09