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RUG -26-2009 11:57 JOHN ROSSI HAY CO. _ 209 823 9326 P.02 <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTA4 HEALTI.I DEPAR,'fMKNT <br />304 East Weber Avenue, 3rd Floor, Stockton, CA 95202-2708 <br />Telephone: (209) 468-3420 fax. (209) 468-343:1 Web; w}vw s' �nv.9reicbd <br />RETURN TO COMPLIANCE CMt'TIFICATION <br />Any MINOR violations noted 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 Department (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 60 days <br />unless otherwise specified in the IR. <br />For this certification t0 be complete the operator of the site must include: <br />• A statement documenting what corrective actions were. taken or will betaken for each violation <br />• Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos <br />verifying corrections <br />• operator's certification <br />Inspection Date; -3—'— 12 — 2:Q 0`:-7 Inspected By: rn (. (1 t . Na l <br />Facility Address:, 6-1 N• YUU2 VUli1 _ EPAII)#: trrc00 .te4-01j6' <br />I 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 fallowing documentation submitted as proof of compliance FOR <br />EACH VIOLATION and I believe the information to be true, accurate, and complete: <br />Photos _)( paperwork __-• _Statement <br />3. lam authorized to submit this certification on behatf of the Respondent. <br />4. 1 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 25191) <br />Name: -b! tvL 4 _ Title:—AI& x' <br />Signature: �WXILfVd6(_� Date: 3—/;—L) <br />nWa 71_n1_nn1; uP„ 11_na <br />