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07/31/2008 22:29 50352dA@kq RUTH HA - BP PAGE 01/01 <br /> SAN JOA{QM COUNW <br /> ENvtatoN►MWTAL HEALTH DEPARTMENT <br /> 600 E.Main St,Stockton,CA 95202-3029 <br /> Td opkotre:(209)468.1420 Fax:(209)468-3433 Web:Xww.aigv otrrJ_elad <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR'violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> coarcted within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental HcWth Department(EMD)address at the top of this form within 35 days of r meipt of the <br /> Inspection Report, <br /> All corrections to other violations noted in the attached Inspection Report 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 /> Note: All EM)staff time associated Waith failing to comply by the above noted dates veld be billed at <br /> the current hourly tate($98). <br /> For this certification to be COM lete the operator of the site multi include- <br /> * .A,. statement documenting what corrective actions were taken or will be taken for each violation <br /> 4 Copia of sample resuits/man€felts/training records/other apptopriste paperwork sttd/or photos <br /> verifying corrections <br /> • Operator's certification <br /> InWection Dates d Inspected By: <br /> Facility Address: /�/ � � FalW -a EPA 1D#: U& a 0 0 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Reportfrom the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be true,accurate,and complete: <br /> Photo$ . Paperwork X Statement <br /> 3. Tam authon7ed m;submit tbis certification on behalf of the Respondent. <br /> 4. I 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 251.91.) <br /> Name: Title:&YICM)Yle � <br /> Signature: Date: D� <br /> EHD 22-02-005 Rev 10-07 <br />