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CRI-Ei ► DEPARTMENT OF TOXIC SI <br />ANCES CONTROL <br />GRAY DAVIS, Govemor <br />SAN JOAQUIN COUNTY UNIFIED PROGRAM AGENCY <br />ENVIRONMENTAL <br />DEPARTMENT- <br />304 E. WEBER AVENUE <br />STOCKTON, CA 95202 <br />TIERED PERMITTING <br />CERTIFICATION OF RETURN TO COMPLIANCE <br />For Permit by Rule, Conditionally Authorized, and Conditionally Exempt <br />Notifiers <br />In the matter of the Violation cited on <br />Located at: (facility address) <br />As Identified in the Inspection Report dated�'� <br />Conducted by: <br />(s)) <br />I certify under penalty of law that: <br />1. Respondent has corrected the violations specified in the notice of <br />violation cited above. <br />2. I. have personally examined any documentation attached to the <br />certification to establish that the violations have been corrected. <br />3. Based on my examination of the attached documentation and inquiry <br />of the individuals who prepared or obtained it, I believe that the <br />information is true, accurate, and complete. <br />4. I am authorized to file this certification on behalf of the Respondent. <br />5. I am aware that there are significant penalties for submitting false <br />information, including the possibility of fine and imprisonment for <br />knowing violations. <br />Name (Print or Type) Title <br />Signature Date Signed <br />ompany Name EPA -ID. Number <br />Revised 3/5/02 <br />