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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT 4-007 <br /> 304 East Weber Avenue,3`a Floor,Stockton,CA 95202-2708 <br /> Telephone.(209)468-3420 Fax.(209)468-3433 Web:www.sj og v�orgjehd E-N WRO, [VI'L:N l'HEALAA <br /> pFRMVT;>SERV[C <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 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 35 days of receipt of the <br /> inspection report. <br /> All corrections to other 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 otherwise specified in the IR. <br /> For this certification t0 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 records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> ® Operator's certification <br /> Inspection Date: 3-2-07 Inspected By: Toua Yang, Kasey Foley <br /> 120 Frank West Circle <br /> Facility Address:Stockton, CA 96206 EPA ID#:CAR000058073 <br /> I certify under penalty of law that: <br /> 1. I have corrected 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 complete: <br /> Photos x Paperwork x Statement <br /> 3. I am authorized to submit this certification on behalf of 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 25191) <br /> Name: George Takemori Title: Division Administrator <br /> Signature: 4Date: 6-14-07 <br /> EHD 22-02-005 Rev 12-04 <br />