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SAN JOAQUIN COUNTY 1 E3 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax. (209)468-3433 Web:www-sigov-or- eC 14 2007 <br /> PERMIT/SERVICES <br /> RETURN TO COMPLIANCE CERTIFICATION. <br /> ations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> This cer i <br /> Any_MINOR viol t fication form must bees to the <br /> corrected within 30 days of receipt of this inspection. receipt of the <br /> Environmental Health Department (EHD) address at the top of this formwithin35 days of <br /> Inspection Report. <br /> All corrections to other viol atio*ns'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 <br /> within 30 days <br /> unless otherwise specified in the inspection Report. <br /> Note: All EHD staff tine --fated with failing to comply by the above noted dates <br /> the current hourly rate ($98). <br /> For this certificati on to be Complete the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will be taken for Zach violation <br /> • Copies of sample results/manifests/training records/other appropriate paper-work, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection- - c- I P <br /> -0_7 Inspected By: U3 <br /> Date: <br /> Facility Address: EPA.ID#: <br /> I certify under penalty of law that: <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 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 /> Photos Paperwork-Statement - <br /> {kgs ul 00AIE <br /> f <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. 9,% <br /> 4.* 1 am aware that there are significant penalties for submitting false information, including the <br /> C 25191) <br /> possibility of a fine and/or imprisonment for known violations. (HS <br /> Name: G Title: <br /> LSignature: Date: <br /> FT4D -02-On 5 P t t/07 <br />