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� . I1�O, lu^ u WLl_lu:::�, <br /> JUN 0 4 2010 <br /> SAN JOAQUIN COUNTY ENVIROWENT HEALTH <br /> ENVIRONMENTAL HEALTH DEPARTMENT PERMIT/SERVICES <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Tele hone: (209)468-3420 Fax:(209)468-3433 Web:www.sigov.org/ehd <br /> RE URN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations n ted in the "Notice to Comply" in the attached Inspection Report must be <br /> corrected within 30 da s 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 30 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 violation , are to be submitted using this certification and returned to EHD within 30 days <br /> unless otherwise specifi d in the Inspection Report. <br /> Note: All EHD staff ti a associated with failing to comply by the above noted dates will be <br /> billed at the cu rent hourly rate of$105 (beginning 8/1/09 the hourly rate will be $115). <br /> For this certific tion to be complete the operator of the site must include: <br /> • A statement docum nting what corrective actions were taken or will be taken for each violation <br /> • Copies of sampler ults/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying correction <br /> • Operator's certificati in <br /> Inspection Date: Inspected By: AytS CRCd-PlA:7, <br /> Facility Address: $ k EPA ID#: CA 000 $;Z7'�33 <br /> L`& 0 t <br /> certify under penalt of law that: <br /> 1. 1 have corrected he violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. 1 have personally examined the following documentation submitted as proof of compliance FOR <br /> EACH VIOLATIO and I believe the information to be true, accurate, and complete: <br /> Photos�Y., Paperwork X Statement <br /> 3. 1 am authorized t submit this certification on behalf of the Respondent. <br /> 4. I am aware that t ere are significant penalties for submitting false information, including the <br /> possibility of a fin and/or imprisonment for known violations. (HSC 25191) n <br /> Name: AVSm Cav�'m Title: <br /> Signature: Date: e,1Z12,010 <br /> EHD 22-02-005 Rev 06/09 <br />