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P . 1 SAN JO&QUIN COUNTY ENtlaotaMEWALIicALIMDii-31A ME.Nrr UN 600 E.. ani St.,Stockton,CA 95x02-3029 2 3 2010 TelephaIIC.(209)468-342a 1,0-(209)468-3 433 WO&'AWA.M,M4 RE,TURN TO CoMpLIANCE CEll FIFICATION Any N1Il�OR violations a*ft l in thy:"Notice to Ctmtply"in the attached ion Ikepoil must be corrected within 30 days orreeeipt of this inspection. This certification form raausibe submitted to the Environmmial IKeatth Deent(EH.D)address at the top of this form within 35 bays of receipt of the Inspection Report- A1129ecCiOns to other va latices noted in the attached Inspection Report or Continuation Forin,or disputes to any violations, a to be sutnrtitted using this aettilication and reunited to EHD withiti 3U daY+s unless otherwise specified'm the Inspection Report. Note: All EHI)staff time associated with failing to comply by the above noted dates Mll be billed at the current hexuiy r (i")- For this certificat on t® be CoMplete the operator of the site must include: • A stateauent dacw Itnti"18 what corrective actions were taken or will be taken for each violation ® Copies of sample ltshnanifestshraining recordstother appropriate paperwork,and/or photos verifying correctic ns e Operator's certification Inspected I IFiS�1CC.irtOA Date: �. Facility A Bd�u#1 I;PA LD#: I certify under penal of law that: i. I have corrected a e violations specified in the laispection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATI N and I believe the infoij nation to be true,aom ate,and complete: Photos_ !' ork Statement 3. 1 tai, authorized tc submit this certification on behalf of the Respondent. I 4. l ani aware that th ucare significant penalties for submitting false infonnnation, including the possibility of a fir, and/or imprisonment for known violations.(HSC 2S 19 1) 14ame: L�— /�Lr Title: Coe Signature: Date: J� END 22-02-0O6 Rev 104 7 I L•d