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03/19/2012 14:24 209367 4 BAGLEY ENTERPRLJES PAGE 01101 <br /> 03119/2012 MON 13:29 Pax 2W553433 sac Neo 14001/00Z <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMgNTAL HEALTH DEPARTMENT <br /> 600 E.Main St,Stockton,CA 95202-3029 <br /> T'el'ephone.(249)4683420 Fax:(209)468-3433 Web:232,siaov.or /8 ehd <br /> RETMZN TO COMPLIANCE C:JERTINCATION <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(Em))address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All correctiDis to other violations noted in the attached Inspection Report or Continuation Form,or <br /> disputes to any violations,are to be submitted using this certification and returned to RHD within 3Q days <br /> unless otherwise specified in the Inspection Report, <br /> Note: All END staff time associated with falling to comply by the above noted dates will be billed at <br /> tate current hourly rate($1 ,. <br /> For this certification to be complete the operator of the site must include: <br /> ® A statement doc=enting what corrective actions were taken or will be taken for each violation <br /> ® Copies of sample results/manifests/training recordslother appropriate paperwork,and/or photos <br /> 'verifying conwdons <br /> • Operator's certification <br /> Inspection Date: Nyvalae 8. ;Lo st Inspected By: i'itu Y - ,paJ <br /> '7't9d0 N. MsGaot�,t G��3s <br /> Facility Address: @tin_ fA�- <br /> kc. <br /> 1t Carne EPA IN:: <br /> T <br /> I certify under penalty of law that: <br /> L I have corrected tate violations specified is the inspection Report from the above-mentioned <br /> inspection state. <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 complete: <br /> Photos.__ V Paperwork statement <br /> 3. I am authorized to submit this certification on behalfof the Respondent. <br /> 4. I 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 2519 1) <br /> Name: selmq 13*91 . Title: fee#i*Mk MWAC-6 . <br /> Signature: Date: 03/1 q/2,01 a <br /> - D 22-02-005 Rev 08/10 <br />