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FROM : L.F.W. MFG. INC. FAX NO. : 209 465 6521 Mar. 09 2007 08: 40AM PS <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />304 East weber Avenuc, 3`d Moor, Stockton, CA 95202-2708 <br />Telepkoize: (209) 468-342.0 Fax: (209) 468-3433 Web: www.sj og v_org/ehd <br />'_ # <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 iii the IR. <br />For this certification to be completethe 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: -2 Inspected By: ??A�? <br />Facility Address: -7 q 5 'S L t� C Ocdt; <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 />r <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: IRW ACUj,5Zrk Title: <br />Signature: <br />7PT7T! 77-117-AA4, V3 v? 1 7 -AA <br />