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Aug 1.8 11 04:63p Harry Singh 209 836 1917 p.2 <br /> SANJOAQUINCOUNTY <br /> EtivntoNNENTAL HF-ALT-[DEPARrMEcv'r <br /> 600 E.Main St.,Stockton,CA 95202-3029 <br /> Te one:(209)468-3420 Fax:(209)468-3433 Web:www.gMly-ors/ehd <br /> RETURN TO CON TLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 3o days o receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health Dep ent(EHD) address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other viol tions noted in the attached.Inspection Report or Continuation.Form,or <br /> disputes to any violations, a 7e to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specified ' 1 the Inspection Report. <br /> Note: All EHD staff time ssociated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate($ , <br /> For this certilication t0 be complete the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will betaken for each violation <br /> • Copies of sample m ultslmauifests/training records/other appropriate paperwork,and/or photos <br /> verifying correction <br /> • Operator's certificat on <br /> F <br /> ction Date: Inspected By:ty Address:A"o jl�S T_ i/1t -E IRAC EPA ID#: C Q -K c)q 0 6 W- <br /> I certify under p lty of law that; er <br /> 1. Ihavecon ed the viiolations specified in the Inspection Report from the above-mentioned <br /> inspection da . <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 true,accurate,and complete. <br /> Photos Paperwork Statement <br /> 3. 1 am authorized to sub nit this certification on behalf of the Respondent. <br /> 4. I am aware that therea significant penalties for submitting false information,including the <br /> fine possibility of an or imprisonment for known violations.(HSC 25 19 1) <br /> Name: , Title: 6 W Al CR <br /> Signature: , <br /> Date: <br /> EHD 22-02-005 Rev o /10 <br />