Laserfiche WebLink
08/08/2008 13:09 5628662787 114 PAGE 02/02 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEA.-TH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 j,", <br /> Telephone:(209)468-3420 Fr x:(209)4.68-3433 Web:ww.w.s v.or e <br /> k93LO-r e , <br /> /0, <br /> 0&1 <br /> RETURN TO COMPLIANCE CERTIF1 <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 oertification and returned to EHD within30days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate ($98). <br /> For this certification to be comp letethe 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: I r5k Inspected By: M,NIMA <br /> Facility Address: EPA ID#: On-Z—� -72—. <br /> a <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following docurneritation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information. to be true, accurate, and complete: <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. [ am aware that there are significant penalties for sibmitting false infon-nation, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 2519 1) <br /> Name: \-A <br /> _Title.- QXYVNk� <br /> C —A) <br /> Signature: Date: <br /> P1411 Rwu 1 1 lfl7 <br />