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01/08/2006 23:01 50352 RUTH HA - BP PAGE 01101 <br /> .SAN JOAQUIN eOltmy � <br /> EWjR(A4 ENTAL HC-ALTH Dr pARTMENT <br /> 00 EQSJ W�-&rjmt&Oddon, CA 952..02 9 <br /> Telep,5ane:{2t19}468.942x1 Fax:(209)468.3433 Web: .sfg�v�o and <br /> - RETURN TO COMPLIANCE CERTIFICATION <br /> Any I violations rioted in The NNotic:e to Cohj in the'af�achad Ins � :, ' <br /> caa wF ph+" pection�R fort rYiust be <br /> a Of receipt of this,inspect 0n.•1-tis vertficatlon farm must be submded to#* <br /> Envtronmentel Health Department(EHD)address at the W a'this form Within--00,days"ofrac�ipt O'- <br /> Inspection Report. <br /> Afi:c_ongons to odw yWaVons noted in the aftached Inspection Report(IR)or ContinuWon Form,.or <br /> dispute9 to any.viOlatibns, are to be submitted using this ramification and returned to EHa"hin <br /> unless OftrMse specified in the Inspection Report, <br /> Mote: All ti-119 staff time assoc faril ng to comply by ft above noted dates%iilI be <br /> t billed at the curmnt hourly rata, <br /> For this certification to be mplet�the operator of the site must include_ <br /> A statement documenting what csorrece actions were taken ar Will be taken for each vlolafr6n <br /> ..Caples df sample resultsimanifests/treining re other appropriaterk,andlOr <br /> �uerifying correalons <br /> 0008t0rls cer#fficafion <br /> Inspection Date.—14)1Ins : <br /> EPA[DO.- <br /> I derf;iy under penalty Of law that: <br /> f. t hive cotrddOd the v018fions specified in the Inspection Report from the abovegwntloned <br /> Ittspeation date. <br /> 2.:' )havae personally examined the folloWing 00CUMentation submitted as proof of oompliance FOR., <br /> EACH VIOCA71ON and I believe the Informatiorr.'to be true, accurate, and complex; <br /> Photos—41X—/1 —Paperwork Statement <br /> 3. 1 am authorized to submit this cat#Itication On behalf of the Respondent. <br /> 4. 1 am aware that there are significant P8119lUes for submitting false inrormation, Including the <br /> possibility of o tine andfor imprisonment for known violations. (HSC 25'197) <br /> Name. Title. ; <br /> Signature- Date: <br /> �H�22-f}�b08 F2eva8� <br />