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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />.rr East Main Street,r <br />29 <br />. .,;i ,.; �x .. mmtbw <br />RETURN <br />COMPLIANCE <br />♦ CERTIFICATION <br />Any MIN violations noted in the "Notice to CompV in -attachedinspectionReport • <br />corrected wfthtjg_4W 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 30 days of receipt Of the <br />Inspection iir <br />i <br />�CMM- <br />billed at the current hourly <br />CopiesFor this certification to be complete the operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• <br />verifyingcorrections <br />``i <br />cit' ` 7":'�k-2- 0 fJ , � °4� ! <br />I have corrected the violations specified in the Inspection Report from the above-mentioned <br />inspectiondate <br />`: personally - -`.',1the following documentation : • iasproof ofcompliance.R. <br />EACH VIOLATION i believe • _ # to be true, accurate, •complete: <br />Photos PaDSrWOrk Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there -significantpenalties for • •false <br />information, including thepossibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />M <br />Date: Z r Z q 16 9 <br />