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... ..,. • ,. ..4.E �: <br /> JUN 14 2011 <br /> s�fd,ri <br /> l;t�,�76f r;.•�,•��'�'fl+fit+t1" <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DbFARTMENT <br /> 600 East Main Strcct,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)468-3433 Web:www.s*Zov,orr_/ehd <br /> RE URN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the attached Inspection Report must be <br /> corrected within 30 da of receipt of this inspection. This certification forth must be submitted to the <br /> Environmental Health Department(EH.D)address at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All corrections to other I iolations noted in the attached Inspection Report(IR)or Continuation Form,or <br /> disputes to any violation ,are to be submitted using this certification and returned to EHD within 30 dans <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 billed at <br /> the current hourly rate (5122). <br /> For this certification t0 be COMPIete the operator of the site must include: <br /> • A'slatement docenting what corrective actions were taken or will be taken for each violation <br /> • Copies of sampl results/manifests/training records/other appropriate paperwork,and/or photos <br /> verifying correct ons <br /> • Operator's certi cation <br /> Inspection Date: �/b /to I/ Inspected By: T h U�j Trc Vl. <br /> Facility Address: S/ P" 51- 7~/'g�� EPA ID#: CAI_0oad-g43/74, <br /> I certify under penaltof law that: <br /> 1. 1 have co eted te violations specified in the Inspection Report from the above-mentioned <br /> inspectio date. <br /> 2. I have pe sonaily llIexamined the following documentation submitted as proof of compliance FOR <br /> EACH OLATION and I believe the information to be true, accurate, and complete: <br /> Photos P� Paperwork K Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware that t re are significant penalties for submitting false information, including; the <br /> possibili of a fie and/or imprisonment for known violations. (HSC 25191) <br /> Name, ash G°vvr- Title: /3-S641'• Masa fZ <br /> Signature: e _ Date: d 11404 t/ <br /> �ur� o�_m_nnc uP.,nQiin <br />