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03/20/2008 15:44 19163725851 SACRAMENTO TERMINAL PAGE 02/07 <br /> . t <br /> SAN JOAQUIN COUNTY <br /> ENVIRLOWEhT('AL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Tdephone (209)468-3420 Fax:(209)4M-3433 Web,y�+w-s'v,oFsr/ebd <br /> RETURN TO COWLMNCE CERTIFICATION <br /> Any MANOR violations noted in the"Notice to Comply" in the attached inspection report must be <br /> corrected within 30 flays 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 35 days of reoeipt of the <br /> inspeotion report. <br /> All cor=11om vLQther violations doted in the attached inspection Report(IR)or Continuation Form, or <br /> disputes to any violations, ars to be submitted using this certification and returned to EHD mithin 60 dans <br /> unless otherwise specified is the IR. <br /> For this certification to be Complete the 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 /> • Operator's certification <br /> Inspection Date: 'Z L Inspected By:P-A-/ Uo1 Kud" <br /> 2?rte Gil- WAc-w*^l ,r .s r <br /> Facility Address: EPA ID#: 6573 Z <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. <br /> 2. I have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATION and I believe the information to be trete, accurate,and complete: <br /> Photos Paperwork V Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I un aware that there aTc sigaiificant penalties for submitting false information,including the <br /> possibility of a fee and/or imprisonment for known violations. (HSC 25191) <br /> Name: Title: vnt <br /> Signature:� Date: v3 !�o <br />