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ROWED ., <br /> UCT l 5 2010 SAN JOAQUIN COUNTY <br /> ENVIRONNIENTAL HEALTH DEPARTNIENT <br /> in Shwt,Stockton,CA <br /> -3029 <br /> ENPE M�Tj RVICESTe Phom. 09)8EALTH 600 t 3420 Faz:(209)468-3433 Web?www.si-eov.orvJ�= <br /> RETURN TO COMPLIANCE CERTIFICATION <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 /> Alf�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 EHD staff time associated with failing to comply by the above noted dates will be billed at <br /> the current hourly rate($122). <br /> For this certification to be complete the operator of the site must include: <br /> • A statement documenting what corrective actions were taken or will be taken 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: August 20, 2010 Inspected By: Garrett Backus <br /> Facility Address: 4071 Calloway Court, Stkn EPA ID#: CAR000074534 <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 following 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. I 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 25191) <br /> Name:�S T-ttai? A Title:jc' "k%Z4- <br /> Signature: C_,c � !L-, Date: ® 0C) Q��10� <br /> EHD 22-02-005 Rev 08/10 <br />