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SAN JOAQUIN COUNTY <br />FMIRONMENTAL IIE'Ai.,iti DITARTME,NT <br />600 t',aStN,1,,1i11 Street., Stockton, CA 952102-30-29 <br />Telephone: (1209) 468-3420 Fax: (209) 468-3433 Web: wivw.sieov.OrL/Lld <br />RECEIVED <br />MAR 0 6 2015 <br />ENVIRONMENTAL OEA:LTI, <br />PERMIT/SERVICES <br />RETURNTO 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 lbrin must be stibmitted to the <br />Environmental Health Department ('13111)),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 theattaf-hed Insmxt-lon Report "IR) or (.'ontlnuation Form, or <br />disputes, to any violations, .ire to be submitted using this cerfification and returned to FIff) within .10 days <br />unless otherwise specified in the lwjiection 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 ($122). <br />For this certification to beCOMPtCtC the operator of the site intist include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />® Copi es'of sample result s/in ani 11ests/trai ni n g record s"Other appropriate papcmv(,) rk, and/or photos <br />verifying corrections <br />• Operator's certification <br />Inspect <br />Inspection Date: ed By: Vj 0-YA Cl <br />a MO -W -14-0-M <br />.1 ccilil*y under penalty of law that: <br />1. 1 have corrmed the violations specified in The lq,,pection Report from the above-nncmtioned <br />inspection date. <br />2. 1 have personally examined the RAlowing documentation submitted as proof of compliance FOR. <br />FAC'f I VIOLATION and I believe the infion-nation to he true, accurate, and complete: <br />Photos —X PapeRvork, Statement <br />3. 1 am authorized to submit this certification on behalf ol'the Respondent. <br />4. 1 am aware, that there are significant penalties tier submitting 11t1se information, including the <br />possibility of a fine and/or imprisonment for known violation,,. (JISC 2S 191) <br />Si(mature: <br />1-1 <br />EIII) 22-02-005 Rev ilk? 10 <br />HE <br />