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11/12/2010 08:56 FAX 2093683234 GEORGE AISHIDA INC la 001 <br />F 0k, <br />; <br />SAN JOAQUIN COUNTY � a �. -. , Yea <br />E NV IRONMF.NTAL HEALTH DEPARTMENT <br />600 F_ Main St., Stockton, CA 95202-3029 NOV 12 2010 <br />Telq*ane: (209) 468-3420 Fax (209) 468-3433 Webs yiv <br />� v. v.or ehd <br />V,ETURN TO <br />COMPLIANCE <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 or Continuation Form, or <br />disputes to any violations, are to be submitted using this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report <br />Note: Ali ERD 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 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 />Inspection Date: % \ x> c r. a Inspected By: <br />facility Address: v, ZS v4�- EPA . <br />��k 2.�O— <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, accurate, and complete: <br />Photos Paperwork V, 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, including the <br />possibility of a fine and/or imprisonment for known violations. (HSC 2519 1) <br />Name: 'P<� e�'_Title:_ <br />Date: tt l�zlr� <br />