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Nov 0712 11:17a HARNAM CORP RATION 20 0-8293 pA <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> I fee East Hazelton Avenue, Stockton,Califomia 95205-6232 <br /> 7 3/epho7e:(209),468-3420 Fax.(209)468-3433 WOb.www-sigov,orglehd <br /> RETL RN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violatioi is not I in the%otice to Comply"in the attached Inspection Report must be <br /> corrected within 30 davs of receipt ,of this inspection. This certification form must be submitted to the <br /> Environmental Hea Depqrtment(EHD)address at the top of this form within 30 days of receipt of the <br /> Inspection Report. SC 2W4.1.2(c)(1) <br /> All corrections to ot r violations noted in the attached Inspection Report(IR)or Continuation Form or <br /> disputes to—a"yol ions,are B be:submitted using this certification and returned to EHD within 36dgys <br /> un otherwise s ified In the inspection Report. HSC 25185(c)(3) <br /> Note: All EHD s; time associated with failing to comply by the above noted dates will be <br /> billed at th current hourlrate <br /> For thisrt' Kation toU., Eomplete the operator of the site must include: <br /> • A statement do men ng what corrective actions were taken or will be taken for each violation <br /> • Copies of sa e resu7manifests/training records/other appropriate paperwork,and/or photos <br /> verifying con ons <br /> • Operator"s ce cation <br /> Inspection Date:_ Inspected By. <br /> 26 -rz I <br /> Facility Address: 43o J�� PcPx,4-/%W Y, 94c, EPA ID#: <br /> C44 S 5.377 <br /> i <br /> I certify under penalty 01f lawthat.- <br /> 1. 1 have corre ed the/l violations specified in the Inspection Report from the above-mentioned <br /> inspection da te. <br /> 2. 1 have persot ally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLP TION and I believe the information to be true,accu9te,and complete: <br /> _Photos Paperwork Statement <br /> 3. 1 amaLdhorized to submit this certification on behalf of the Respondent. <br /> 4. lam aware ftt there are significant penalties for submitting false information,including the <br /> possibility of fine a!!nd/or imprisonment for known violations. (HSC 25191) <br /> Name: �oir SCC r Title: 01a M x--.< <br /> Signature: Date: //-- 0 7 - <br /> EHD 22-02-005Rev W19f12 V <br /> "%PwCE1% "w"Opff" <br /> ri tLj <br /> NOV 0 7 2012 <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />