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%08/,13/2009 04:18 2098873408 KAREN ARNAIZ PAGE 01/06 <br />$AN JOAQUIN COUNTY <br />EwRommENTAL HEALTH DEQ ENT <br />6W 53rA Main SftK Stoddon, CA 95202-W29 <br />Telepho,ne.- (209) 468-3420 Fax- (209) 468-3433 Web. WWW s1kWV.0 JA IV <br />RETURN TO COMPLIANCE CERTIFICATION <br />;rjT Z <br />rMUM-1=0W —VIMU'r, i <br />Environmental Health Department (EAL)) 8dar"S 9t lle'ds'p OY -uls <br />Inspection Report. HSC 25404-1.2(c)(1) <br />- I & -1111181� <br />WEN =7RIA7 � a i � �# t 1. I IMP7. - I i :� ;1�= <br />ajSpUWS to apy 1jjj1.�-,U4Vj6, Aji W-i-17,9177ulwaLt 7-,WFA—'% B-21�0-ME"RiT�2XI: <br />unless 0#*pMse specmed in the Inspection Report HSC 25186(CX3) <br />tOr,-� above n6W dates will <br />4 <br />1111111111111111117 <br />For this certification to be coMpletethe opwator of the site must indude- <br />A swernent dommentim what conectiVS aGUOnS wem taken or vAR be taken for each violation <br />Copies of sample maWmanffests/training records/other appropriate i8 ,r 81"KyOr Photos <br />vewng corrections <br />OperaWs mrfification <br />si <br />I t 1-14 <br />.' 1 1) 1 4 - 0" . C : f . <br />1, 1 have corrected ft vlolsMons spectfied in the Inspectfort Report from the bo 1; <br />inspection date. <br />2- 1 have personally exarydned s! doommtatim submitted as Proof d compliance FOR <br />SACH VIOLATION and I believe the infornmdon to be true, accurate, and complete: <br />s er.- r r e- <br />4, 1 am aware that there are significant pensities for submilft Use Irdormallon. inewing <br />possibility of a Me andfor impi-Isonment Ibi Viown violations. (HSC 25191) <br />Date: 1 *7 -.2 3 - <br />EW 22-R rteV Deva <br />- <br />EW22-R-M1teVWM1 <br />