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�ac�2fooz 11/26/2008 11 35 FAX SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Stvet stockton,CA 95202-3029 Telephone:(209)468-3420 Fax:(209)468-3433 Web:ww'w sieou.arf*Jehd RETURN TO COMPLIANCE CERTIFICATION Any MLtj R violations noted in the"Notice to Comply„ in the attached Inspection Report must be corrected> 3 da of receipt of this inspection. This certification form:oust be submitted to the Environmental Health Department(EHD) address at the top of this form witliin :IS days of receipt of the Inspection Report, All corrections to other Aglations noted in the attached Inspection Report(JR)or Continuation Form,-or disputes to any violations,are to be submitted fusing this certification and returned to EHD within 317 unless otherwise specified in the Inspection Report, a Nate: Ali EHD staff time associated with failing to comply by the above noted dates will be balled at the current hourly rate. For this certification t0 be complete the operator of the site:must include: • A statement documenting what corrective actions were taken or will be taken for each violation • Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying corrections — • Operator's certification Inspection Date: Inspected By ,__:I t Address: d EPA ID#6e000� 9 � I certify under penalty of law that. 1, I have corrected the violations specified in the inspection Report from the above-mentioned inspection date. 2. 1 have personally examined the following documentation sub�ccura tted s prop complete:compliance FOR EACH VIOLATION and 1 believe the inform tion to be �e, Fhotas Paperwork P statement + 3. 1 am authori7.ed to submit this certification on behalf of the Respondent. 4, I am aware that there are significant penalties for submitting rifalse HSC 2519 1) including the possibility of a tine and/or impnsoriment for mown violat o Title: Dame: N' C14 aY Signature: �,;