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09/07/2007 08:04 2094749151 HAMMER 15 ARCO PAGE 01/02 <br /> SAN JOAQUIN COUNTV <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202.3029 <br /> Telephone:(209)468-3420 F=(209)468-3433 Web:www.9Jeov.o <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached inspection report must be <br /> corrected within 30 day, 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 violations noted in the attached Inspection Report(JR)or Continuation Form, or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 60 dans <br /> unless otherwise specified in the IR. <br /> For this certification to be complete the 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 rccords/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> en <br /> • Operator's certification <br /> Inspection Date: `n-1 Inspected By: JNI�.At <br /> Facility Address: 515D Lj, L-ke., EPA ID#: CAL_ <br /> Cc— 95205 <br /> 1 certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <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 complete: <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:_�j Title: <br /> Signature: Date* 1,C-7 <br /> VTJTN,),)_n,)_nn4; ]?.-%r A4/A7 <br />