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JUL-22-20C,1'31 C14: 1GP FRnri: T0:458343.3 P. <br /> JUL-2-8808 03:07P FROM:JIMCQ�P3 - �- <br /> 18095997115 x:18098385307 p,2 <br /> SAM JOAQUiN COUNr'v <br /> ENViRONMEWAL HOALTH DePAR'TMENr <br /> 600 EAM Main$tree4 Steckto%CA 93202-31029 <br /> -- Mop kand. (209)458-3420 Buz(300)469-3433 Web:www.dgRX om1ghi <br /> w <br /> RETURN TO COMPLIANCE CERTIRCA-77ON <br /> Any MANO violations noted in the"Notice to Compiy"in the attached Inspection Rurort must be <br /> of receipt of this inspection. This certification form must be submitted to the <br /> Eevhommental Health Dgmtlncnt (EHD)8ddre"at the top of this form within 35 days of receipt of the <br /> Inspection Report. <br /> All eo sti noted in the attached Inspection Report 0R)or Continuation Form,or <br /> disputes to any violations,are to be submitted using this certification and returned to EHD w thi da <br /> ya <br /> unim odu wise specified in the Iaspection Report <br /> Note.: All EUD strtff time•awClated with fairing to compiy by the above noted dates wil1E be Wed at <br /> the current hourly rate($98). <br /> For alis certification to be Complete the operator ofthe site must include: <br /> A statement documenting what corrective actions were taken or will be,taken for each violation <br /> Is Capias Ofsample caults/manifests/training records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> + Operator's certification <br /> Inspection Date: Co Inspected By: <br /> Facility Address: t rZ Z 1`" -` 110 7-A-0`6EFA LD#: <br /> I certify under penalty of law that; <br /> 1. 1 have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I have personally examined the following documentarion submitted as proof of compliance FOR <br /> EACH VIOLATION and i believe the information to be true, accarato,and complete: <br /> Photos PaperworkStatement <br /> —X-- <br /> 3. lam authorized to submit this certification on behalf of the Respondent. <br /> +4. T am awam that there aro significant penalties for submitting false information, including the <br /> possibility of it fine and/or imprisonment for known violations. (HSC 25I 9I) <br /> Name: 1� 4 i/ / kJ C L J —1,. Title: )A--k r-- I'J <br /> Signature: - Date: 'r f <br /> ctrr.��1t«-M�r nav 12107 <br />