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FROM LAKEWOOD . PHONE NO. : 209 3336306 0 Jul. 30 2007 11:46AM P2 <br />SAN JOAQUIN COUNTY <br />F,NVIRONMENTAL HEAL-TH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 far: (209) 468-3433 Web: w4�19!64 <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 />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 to be COMPI&e 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: :1 A -0 / r <br />Facility Address: 6 <br />el <br />A0CQ Sze% <br />t certify under penalty of law that: <br />Inspected By:,�( <br />EPA ID#: <br />I- I have corrected the 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 VIOLATION and I believe the infornWion to be true, accu^5�, and complete: <br />_._Photos _ _paperwork Statement <br />3. 1 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 />Title: 04ko/- <br />Date: <br />