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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />7_419 TAITILAP �t�kujl �%T&&jfr�v <br />10:40 <br />i M, <br />aGaress at Ine lop oT Inis TornriTzMM-301111-01 <br />Inspection Report. <br />All corrections to other violgtions noted in the attached Inspection Report (IR) 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 EHD staff time associated with failing to comply by the above noted dates will iz <br />billed at the current hourly rate. <br />For this certification to be�completethe operator of t ' he site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample results/mani ts/training records/other appropriate paperwork, and/or photos <br />verng corrections <br />• Operator's certcation <br />Inspection Date:'1"e <br />301 Z- h 0 Inspected By: <br />Facility Address: ISr1!L-)c lPU)t4, EPA ID#: <br />1. 1 have corrected the violations specified in theInspection Report from the above-mentioned <br />inspection date. <br />�:r_"T4j'IVAM WTAI [4304 <br />Photos -Paperwork Statement <br />4. 1 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 25191) <br />Title - <br />111111111 M. <br />EHD 22-02-005 Rev 10/09 <br />N <br />