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F�20M :'"QAC INVESTMENT FAX N0. :9164897113 Jan. 10 2807 02:21AM P2 <br />SAN JOAQUIN C OUNTX <br />PNV1RONMEWYAL HLAL'm I7n'ARTMENT <br />600 E. Main St., Stockton, CA 952(x2.3029 <br />''LJtenlRonc (209) 468-3420 1"ax. (209) 468-343.3 Wch; www civ.gr (ehcl <br />RETURN TO COMPLIANCE CERTIFICATION <br />Any MINC)R violations noted in Lhe "Notice to Comply" in the attached Inspection Report must. be <br />corrected within R clays of receipt of this inspection. This certification form must be submitted to the <br />Environmental i lealth Department (EIID) address at the top of this fornt within 35 days ol'reccipt of the <br />Inspection Report. <br />All corrections to other violations noted in the attached Inspection Report or Continuation Forni, or <br />disputes to ,any violations, are to be submitted using this certification and returned to EHD within 3Q days <br />unless otherwise specified in the inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be billed at <br />the current hourly rate (S98). <br />For this certification to be complete the operator ol'the site must include: <br />• A statement documenting what corrective actions were taken or will be taken lbr each violation <br />• Copies 0I'sample results/manifests/tnaining records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspection Date: _. a t t , <br />Facility Address: g B n 'c G i W. <br />Cha, <br />1 certi fy under penal ly of law that. <br />Inspected By: a�Y��J,—,a�.., � <br />FPA I.D#.:_.. C. QD_2?� .. F . <br />1. i have corrected the violations specified in the .Inspection Report from the above-mentioned <br />inspection dai:e. <br />2. I have personally examined the following documentation submitted as proof oi'compliance FOR <br />FACH VIOLATION and I believe the iniitrmalion to be true, accurate. and complete: <br />Photos -Paperwork Statement <br />3. 1 am authorized to submit this ecrtifieation on behalf of the Respondent, <br />4. 1 arra aware that there are significant penalties Por submitting false information, including the <br />possibility of aline and/or imprisonment fir known violatiorts. (HSC; 2S 1 yl ) <br />FI IL) 22-02-005 Rev 10-07 <br />Date: ,,... (a go,22 I <br />