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r <br />SAN JOAQUIN COUNTY <br />ENVtRQNMENT <br />�+ <br />NTAL HEALTH DEPARTMENT <br />600 East Mairt Street, Stooldon, CA 98202-W29 <br />T :lone: (209) 468-3420 Few (209) 33 Mb. wwijgogmkhd <br />01101p] ill I - 0' <br />�, s _ rA • i ► r d •,:c <br />lit L7. M1 trli770 A <br />F1 - '♦ a F11'Ow • ♦: •.. c•: • r r_ 1"It., 7;5=11.111j77=1174 <br />' <br />Note: All EHD staff time associated wiling to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this certification to be complete the opewor Of the site must Includw. <br />• ' statement documenting corrective actions Were takenor ♦: taken for • Y: <br />• Copies of sample resultafmanifests"ning records/other appropriate papenvork, andfor ph <br />verlyng corrections <br />a <br />t: r is I s. <br />A♦ i : s t + P , .::. fir + j ,: <br />I cerffy under penalty of law that <br />I I have coffected the violations specified In the Inspection Report 11rom the above-mentioned <br />Inspection <br />.-•... date. <br />2. 1 have personally examined the follovAng documentation submitted as prod of compliance FOR <br />EACH VIOLATION and I believe theinformatiorr to tie We, accurate, and complete: <br />r <br />