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Page 1 of 1 <br /> E C,JE�V EL-DD <br /> U(J 2 1 2010 <br /> SAN JO&QUIN Couwn EVVIRUN11r'IEW HEALTH <br /> ENVMONNE97AL H&ALrR WA=MINT <br /> 600 Eon main$tree,stodtoa CA 95=.3029 PERMIT/SERVICES <br /> Trhpiww,(209)461-UN Peal(209)468.3433 Witt vww liaoyAWhd <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the"Notice to Comply"in the atatcbcd ingpaetlon Report roust be <br /> coatecteQ within 30 clava of receipt of dhic inspection. This eenifiestion form must be cubmitted to the <br /> Bnviru==al Health Department(EHD)addrea at the top of this farm within 35 days of receipt of the <br /> htspcction Report, <br /> All c,,oaecions ig goer vmlationa noted in tho attached Inspection Ripon(IR)or Continuation Form,or <br /> disputes to any violations,arc to be submiticd using this certification and returned to EHD within 3l)days <br /> aelcse otherwise specified in Tho Inapocdon Report <br /> Note; All END staff lithe asa•cialed with fiillng to comply by the above noted dittos will by billed at <br /> The comsat bouriy rats(SI 21). <br /> For this certification to be COmplete the operator of the site must include: <br /> • A staterttent domunting whet comae Live actions were taken or will be taken for each violation <br /> • Copies of asmple teaults/tnanife9s1t Wnina recetds(other appropriate paperwork,and/or photos q� <br /> verifying carmctiaasj�tn���C r� �e�IrL` 1�U6 ( GlV � rY��m� <br /> • Operator's certification 11� ,iJof� <br /> -k�r\s <br /> Insp=tIon Date: �� 10 Inspected By; mu '?'MNada <br /> Faciliry Address & EPA ID#:CA L Pxa Al <br /> I certify under penalty of law that: <br /> ry <br /> 1. 1 have correatcd the violstions specified in`the Inspection Report from the above-mentioned <br /> inepcction date, <br /> 2. 1 have personally exmined(he following documentation wbmlacd as proof of compliancc FOR <br /> EACH VIOLATION and I believe the infomuttion to be tntc,accurate,and couiplctc: <br /> Photos _Paperwork Stabcuicnt <br /> 3. 1 am authorized to submit this certification on behalf of the RcaporydenL <br /> 4. l em aware that there arc significant penalties for submitting false information,including,the <br /> pcesibiliry of a fine and/or impaisotuncrtt for known vialatiorts. (HSC 23191) <br /> Nemo' Title r Js✓ ✓`� <br /> Signature: Date: <br /> EH D 22-02-005 Rev OW 10 <br />