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11/06/2007 16:11 FAX 2093683234 GEORGE RISHIDA INC IM008 <br />SAN JOAQQUIN COUNTY <br />ENVIRONMENTAL HEALTii DEPARTMENT <br />600 bast Main Street, Stockton, CA 95202-3029 . e <br />Telephone: (209) 468-3420 Fa (209) 468-3433 Web: =K.js j—.1�ovor —hd <br />RETURN TO COMPLIANCE CE TI CA ION <br />Any MINOR violations noted in the "Notice to Comply" in the attached inspection report must be <br />s inspection• This certification form must be submitted to the <br />corrected within 30 dam of receipt of thi <br />Environmental Health Department (EHD) address at the top of this form within 35 days of receipt of the <br />inspection report. <br />corrections to other violations noted in the attached Inspection Report (IR) or Continuation Form, or <br />All <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 60 dam", <br />unless otherwise specified in the IR. <br />'For this Certification t0 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 />*Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br />Verifying corrections <br />• Operator's certification <br />Address:Inspection Date: %% 10 ( bI Inspected By: <br />Facility , <br />I certify under; penalty of law that: <br />1. I have corrected the violations specified in the inspection Report from the above-mentioned: <br />inspection date. <br />2. I have personally examined the following documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, wxmte, and complete: , <br />Photos ,`- Paperwork w- Statement <br />3. I am authorized to submit this certification on behalf of the Respondent. <br />4. I am aware that there are significant penalties for submitting false information, incl the <br />possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br />Date: ®1(`$ ( 0-'1 <br />-- nn nne rb — nr H107 <br />