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0\ 0 0 t <br /> .002454 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telop.'?one:(209)468-3420 Pax.,(209)468-3433 Web:wwW,§j_q0v.qr_q1ehd, <br /> RETURN TO COMPLIANCE CERTWICAMON <br /> Any MINOR violations noted in the"Notice to Comply' in the attached Inspection Report must be <br /> corrected within 20 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Depaitment(EHD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report. <br /> All corrections to other Violations noted in the attached Inspection Report(IR) 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 /> I <br /> Note; All EHD staff time associated With falling to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to beCOMP16te 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 samoie results/manifestsitraihing records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> ® O erator's certification <br /> Inspection Date: to--Z::l — Inspected By:iNgx� <br /> Facility Address: EPA ID#: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the-inforrhation-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 /> I am aware thet there are significant penalties for submifting false information, including the <br /> possibiiity of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Mame:e-&SV\K—VA;X-& Title: �.. ,J VC-L, <br /> re. n-ag - <br /> Signature: Date <br /> EHO 22-02-005 Rev 08= <br /> I r <br /> S/2:aGed S621Lt122602:LU0jj 6T:60 TTw-62--inf <br />