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• SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMEN. <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Te phone:(209)468-3420 Fax: (209)468-3433 Web:www.sieov.or /�ehd <br /> RET RN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations oted 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 D partment (EHD) address at the top of this form within 35 days of receipt of the <br /> inspection report. <br /> All corrections to other v olations noted in the attached Inspection Report (IR) or Continuation Form, or <br /> disputes to any vi lation are to be submitted using this certification and returned to EHD within 60 days <br /> unless otherwise pecifie in the IR. <br /> For this ce lflca loll to be complete the operator of the site must include: <br /> • A statem nt documenting what corrective actions were taken or will be taken for each violation <br /> • Copies o sample results/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying orrecti ns <br /> • Operator' certification <br /> Inspection Dat : Feb uary 12th, 2008 Inspected By: Michelle Henry <br /> Facility Addres : 153 . 11th ST, Tracy, CA EPA ID#: CAL000324141 <br /> I certify unde penalty of law that: <br /> 1. I have co ected t e violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have per onally, xamined the following documentation submitted as proof of compliance FOR <br /> EACH VI LATI N and I believe the information to be true, accurate, and complete: <br /> Photos Paperwork X Statement <br /> 3. I am autho-ized to submit this certification on behalf of the Respondent. <br /> 4. I am awar that there are significant penalties for submitting false information, including the <br /> possibility of a fine and/or imprisonment for known violations. (HSC 2519 1) <br /> Name: Thomas S. exton Title: Environmental Specialist <br /> Signature. Date: April 30th, 2008 <br /> EHD 22-02-005 R.ev 05/07 <br />