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RECEIVED BY SJCEHD (EF) on 3131120 <br /> SAN1OAOUIN Erlvlr�,t�rrrs:r,ta114aa1tl, D�{�artsteen�- <br /> RETURN TO COMPLIANCE CERTIFMATION <br /> __..seux,Vrulallan5 rygrgq M the NabpB tU Gorrlt>ty-jt�j♦ve OZy fjeyy Irvgpertyun P ,.�.t m.y�•a, _ N <br /> rBL�@rpt o1 this rngAf}Cfran rr7le r-".�rtl Wn form MttM1 t:R sribm,tler;MI nE Elyvu r+nrss wal vtftMl1, 1 <br /> ri. �[E�tG,cryr.S�rNs� <br /> rrr 1�Tr4ni or rh,r to,,,wlrr,n 30 d$ya or rer.*ip4 t,t ltla lnzV-iiar.Repun "'V",VWIA a�[c�l.ti <br /> Arl fiATY�ttlons[n Qthr r,t, n}iga+n lhE a7sachea In3,wC.t1C}n RCport li>;Cr Cr+rrprllill0an Fnem Qt( <br /> vroiatrons, ara to t]q submIlu d using 1h%-cerllfi;allnn anri re-t,Irrsd try EHL Mtrr.n 30��rL/Yel otlt6sw,s� <br /> Ir:asa uMon R,"ort HSC -51as{clt:t <br /> ote: All EH❑staff time associated with falling to Cvmpty by the above noted dates <br /> b€fled at the Current hourly raga. <br /> For this certification to be complete, the operator Qt the site rr,,,st mdlr4e <br /> A Statement documenting what corrective actions wars taken or will be taken tW ears,vlgtalfcr, <br /> coptas of sample resuWmanlfeststtraining rec4rdstother apprrspriate paperorvrk,anwor pnotG9 vrarlty+n9 u <br /> Operator's certification <br /> pection Date: February 21, 2420 inspected 8X: El_tANt+W FLQRttX]' - <br /> ,alGi[ity Address: 12455 E MINER ST, STOCKTON CERS iM 10796905 <br /> rtify under penalty of law that <br /> T 1 have correeml tate vllIfians specified in the InspeCtOn Report from the atmva-mennneo tnmvectton dift <br /> t have personally examIned ttte following documentation submitted as Prost of corn0bance F vkmAnarl <br /> anis i believe the informaitlon to be true, accurate. and complete <br /> Photos Paperwork Statement <br /> 3- 1 am authorized to subrnit this certification on behalf of the Respondent <br /> r4. l am aware that there are significant penalties for subrrlltking fatsa inttxmatum.inOjding 01 POSSWI 018 Tuve andfor <br /> impriSonment for known violations. (HSSC,r 25191) <br /> r3 ! r L Title: <br /> Name, <br /> Date'. <br /> signature: <br />