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SEP -18-2006 MON 09:45 AM jqf� STOP MARKETS FAX N0. 51 571544 SAN JOAQUIN COUNTY ew,RONMENTAL HEALTH DEPARTMENT 304 East Weber Avenue, 3`d Floor, Stockton, CA 95202-2708 Telephone: (209) 468-3420 Fax: (209) 46&3433 Web: S'" eh I lk Any I I qoR violations noted in the "Notice to Comply" in the attached inspect ion repo r must be coapt to i within 30day§ of receipt of this inspection. This certification form m .ist be sul mitted to the Environ rental Health Department (EH D) address at the top of this form within 35 days r f receipt of the jnspec )n report. All coir . ons to o er violatio noted in the attached Inspection Report (IR) t �r Conti � anon ]Form, or disputes to any violations, are to be submitted using this certification and return �d to EF) ) within 60ams unless a therwise specified in the IR. For t] 11S CeErtEl Cation to be completethe operator of the site m xst inclu e: e► A statement documenting what corrective actions were taken or will be taken fbi each violation 40 Copies of sample results/manifests/training records/other appropriate p;iperwor and/or photos verifying corrections aoperator's certification inspec Bion Date: ' ® _ _inspected By:_ Facilit Address:�o S EFA #: I ct rtify under penalty of law that: -1. 1 have corrected the violations specified in the Inspection Report from the abo ; -mentioned inspection date. I I have personally examined the following documentation submitted as proof of, .ompliance FOR. EACH VIOLATION and I believe the information to be true, accurate, and co plete: Photos !!!!�Paperwork elStatet lent 3. 1 am authorized to submit this certification on behalf of the Responder: t. .4. Tam aware that there are significant penalties for submitting false information, ncluding the possibility of a fine and/or imprisonment for known violations. (HSC 15191) N;mie:�!�'k ✓ �d _Title: ,i¢�4: ►.� v,i✓. � � f �' Date: ® Si mature: �-- wTxri o)'_r»-nt1K Rp.v 1,7-64