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0 9 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax. (209) 468-3433 Web: www.s*qov.org/ehd <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 this certification and returned to EHD within 30 days <br />unless otherwise specified in the Inspection Report. <br />Note: All EHD staff time associated with failing to comply by the above noted dates will be <br />billed at the current hourly rate. <br />For this certification to be completethe operator of the site must include: <br />• A statement documenting what corrective actions were taken or will be taken for each violation <br />• Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />IM33��B� <br />4-T41114TATT, =: <br />F -MM <br />Inspected By: <br />1. 1 have corrected the violations specified in the Inspection Report from the above-mentionea <br />inspection date. <br />IIIIIIIIIIIIII0AX61ML I <br />Tj [0] WAT <br />Photos Paperwork Statement <br />gel-gj 1!11111 VAOJ ff; a I I I V -X; I I L-krzej a I I I If] g 6i*A a I 11 ['74 Ila cola A A 16171711 ILYA Lei M4 M a u-MR1 <br />717 -RM <br />EHD 22-02-005 Rev 08/08 <br />Es <br />