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08-02-07 04:17pm From-TAIT ENVIROMENTAL 714-560-8237 T-338 P.03/06 F-937 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTIi DEPARTMENT <br /> 6th Eut Main,Street.Stockton,CA 95202-3029 <br /> Tel ne:(209)468-3420 Fax:(209)468-3433 Web: +w_sig v p 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 wi 0 dM of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EMD)address at the top of this form within 35 days of receipt of the <br /> inspection reporL 'Permit application was submitted on 7/13/2007 . <br /> An MRP will be sent to you when the work is complete <br /> All corrections to Sther violations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> disputes to any violations,are to be submitted using this certification and returned to EHD_within 60 days <br /> unless otharwise specified in the IR. <br /> For this certification t0 be complete the operator of the site roust 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 /> • Operator's certification <br /> Inspection Date: Inspected By._ <br /> Facility Address: 124 West Elm S t . Lodi EPA : <br /> I certify under penalty of law that: <br /> I. I have con=W the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I 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 Tete: <br /> Photos Paperwork Statement- <br /> 3. I am authorized to submit this certification on behalf of the Respondent. <br /> 4. I =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. w 110egapi) Title: Cis-����1• '`�'�/�. / %� <br /> Signator w ate: ��'? <br /> EHD 22-02-005 Rev 05/07 <br />