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FROM FAX NO. lar. 09 2009 03:47PM P1 <br /> ,•,:+' . <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA,95202-3029 <br /> Tele hone:(209)468-3420 Fax:(209)468-3433 Web:www.siQov.orglelyd <br /> kET1 TRN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 dans of receipt of this inspection. This certification form must be submitted to the <br /> Environmental Health D artment (EHD) address at the top of this form within 35 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 Ef l) staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate. <br /> For this certificat on to be complete the operator ofthe site must include: <br /> • A statement documenting what corrective actions were taken or will be taken for each violation <br /> • Copies of sample esults/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> a Operator's certification <br /> Inspection Date: 01 &_e) Inspected By: #1 'G e/ G �n ery <br /> Facility Address: S! W I/?" Fr q!jY EPA ID#: Cd L OOo d 98 17 6 __ <br /> 1 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 VIOLATI N and I believe the information to be true, accurate, and complete: <br /> Photos X Paperwork X Statement <br /> 3. 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4. I am aware 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: plc!(_ S t JIZALk Title: ?a- r-x, / <br /> Signature: Date: 3 9lO <br /> 9"r) 2?_0?_n05 Rev 11/0 <br />