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Jul 13 10 01 : 11p HIGH SPEED TRANSMISSIONS ( 209) 463-4067 p . 3 <br /> _ SAN JOAQUIN COUNTY _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 Fast Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 466-3420 Fax:(2UU) 468-3433 Web:wwwsigov orn)ehd <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 30 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 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 <br /> billed at the current hourly rate. <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 be taken for each violation <br /> • Copies of sample results/manifests/training recordslother appropriate paperwork, and/or photos <br /> verifying corrections <br /> Operator's certification <br /> Inspection DateInspected By: <br /> :--� <br /> Facility Address:aq �Ft2 ^4h�ST EPA ID#: C-�L MC3300SVC <br /> 54k yeti CG- <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. 1 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. 1 am authorized to submit this certification on behalf 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. `n'e-AC1nQ Title: <br /> Signature: t Date: 7 V <br /> EHD 22.02-005 Rev IWOO <br />