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E <br />C7 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTu DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />0, 1111111"111 <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 />Note: Ali EHD staff time associated with failing to comply by the above noted dates will be billed at <br />the current hourly rate ($122). <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/otber appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: July 15, 2011 — Inspected By: Garrett Backus <br />Facility Address: 1469 E Hammer Lane EPA ID#: CAL00034237 <br />2. 1 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 />Photos / Paperwork — Statement <br />3. 1 am authorized to submit this certification on behalf of the Respondent. <br />4. 1 am aware that there arc significant penalties for submitting false information, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Name:— e:!j_44L01 --Title: <br />Signature: Date: <br />1,09H <br />