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.002454 46 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East,Main,Street, S,:)ckton,::A 95202-3029 <br /> TeleF:�one:(200)466-3420 Fax:(20t.)458-3433 Web:www.$)aov.ora/ehd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 days of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Department(EHD) address at the top of this form within 30 days of receipt of the <br /> Inspection Report. <br /> All corrections to other violations noted In the attached Inspection Report(IR)or Continuation Form, or <br /> disputes to,any violations, are to be submitted using Ibis certification and returned to EHD within 30 days <br /> unless otherwise specified in the Inspection Report. <br /> Note: All EHD staff time associated with fallirt-g to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification t0 be Complete thdoperator of the site must include: <br /> • A statement documenting what corrective actioV were liken or will be taken for each violation <br /> • Copies of sample results/manifests/tralning reccds/othE,Y appropriate paperwork, andlor photos <br /> verifying corrections <br /> • O 'rator's certification <br /> Inspection Date:---,- 711312,612, '4 Inspected By: 4,eiv 4ol 01 <br /> Facility'Address: / 7 2/-,I. So. Cl*eakee L4. EPA ID#: C/4L D'y S 9,1,6 <br /> I certify under penalty of law that: <br /> 1. I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. I <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the1riformation•to be..true, accurate, and complete: <br /> Photos_Paperwork Statement <br /> 3. 1 am authorized to submit this certification onbehalf of the Respondent. <br /> 4 1 am aware that there are significant penakie,for sutpitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 25191) <br /> Name: � -t s AWk itle: , R.��'ad. rR, <br /> Signature. L bate- <br /> EHD 22-02-005 Rev 08/08 <br />