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co <br />SAN JOAQMfq CO <br />ENWROMENTAL HEALTr4 DirPARTmPxT <br />1869 E H=1ton Ave., Stockton, CA 95205 <br />T-019Pho-Re., (209) 468-3420 F= (209) 468-3433 Weh: w 'gqv Id <br />jVX.M orgIgL JAN 12 <br />RETURN TO COMPLIANCE CERTIFICATION <br />1111 1 1 N <br />aJLMLV0M iiA A.10 Lk)ffl 1111 EIL5 L4j'(,jjj ITTRIET 33 uays of receipt of <br />1-upection Report. <br />All ZO—rrecttil s "her vMgl'ii s noted in the attached Inspection Report or Continuation. Form, or <br />disputes to M 2A L-VILMM—W-ar0"; fn,4- <br />unless otherwise specified in the Inspection Report. <br />Not . e., All EHD staff time asso4ited with falling to comply by the above noted dates will ,e, <br />the current hourly rate ($125). <br />For this certification to be complete the operator of the site M,.t include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies ofsample at t. records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />fmspection Date: "'k) 1- Do m Mspected By: Ac' -ec� <br />�s v -%gs <br />FacilityAddrew—SS01At EPA M#: <br />I certify under penalty of law that, <br />T have corrected the violations specified in the Inspection Report from the above-mentionei <br />inspecti on date. <br />2. 1 have Personally examined the following documentation submitte . d as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />-----Yhotos 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 flne.and/or imprisonment for known -violations. (HSC 25191) <br />Date: () I 't2-- 1-5— <br />