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11/02/2005 11:14 MCI 4 17007775870 N0.415 904 <br /> IMF MW <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTIi DEPARTMENT <br /> 304 East Weber Avenue,Yd Floor,Stockton,CA 95202-2709 <br /> Telephone.(209)468-3420 Am:(209)468-3433 Web;wWWj%jLov-org1ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <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. .1. 1 <br /> All corrections to other violations noted in the attached Inspection Report(IR)or Continuation Potm,or <br /> disputes to any violations, are to be submitted using this certification and returned to EHD within 60 days <br /> unless otherwise specified in the IR. <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/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> * Operator's certification <br /> Inspection Date: I �® '® Inspected By: AA_- ' co-CLA 04) <br /> Facility Address: Aj e EPA IN:C A-LO QQnQ 2 61 L <br /> %5336 <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 ofcompliance FOR <br /> EACH VIOLATION and I believe the Information to be true, accurate,and complete, <br /> Photos ZPaperwork Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent_ <br /> 4. 1 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 25191) <br /> A)A 1460— CtqjLkf <br /> Name- Title: -j <br /> Signature: K 0-,, Date: W3- <br /> EHD 22-02-005 Rev 12-04 <br />