Laserfiche WebLink
SAN JOAQUIN COON ty <br />ENVIRONMWAI HkAtlHD1`VAl1IWNf <br />1860 test Haselton Avenue, httwklon, C oIllowle 00904 AM <br />nn a <br />TelspAone: (204) 456.9420 Par;1209) 460,3439 Webr wyrw.aWuY.wWsful `J` I <br />010 <br />RETURN TO COMPLIANCE CERTIFICATION dols <br />Any MINgg violations noted in the "Noltoe to Comply" In the attached Inspection NOP00 nursf he <br />gg )ptttht(1,l�i.f�AYi of realpt of this inspection. This certification form rutat be olihrrilforl Io the <br />Environmental Nealih Department (EHD) address at the top of this form within 90 days of fecelpl of the <br />inspection Report, NSC 25404.1 2(c)(1) <br />All co one to gthawlole Iona noted in the attached Inspection Report (IR) or ConilnuetlOn F01111, or <br />disputes to any violations, are to be submitted using this certification and returned to f HG WWJUI J9. Will <br />unlessoth*rwise specified in the inspection Report HSC 25155(c)(3) <br />Note All EHO staff time associated with falling to comply by the above noted dates will be <br />billed at the current hourly rate, <br />For this certification t0 be Complete lho operator of the site must Include <br />• A statement documenting what corrective actions wore taken or will be taken for each violation <br />• Copies of sample resultslmonifestsnreining records/other appropriate paperwork, and/or pholOe <br />m <br />verifying corrections <br />. Operator's certification <br />Inspected By:Zareef <br />Inspection Date:_ 1 U=� — O1 3 <br />3077 E, Hammer Lane CAL000390123 <br />Facility Address, EPA IDM: ��_-�_._ . ._.. -_. <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. 1 have personally examined the following documentation submitted at proof of complienc4 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 28191) <br />w <br />EHo 22-02.005 ROY 04119/12 <br />Title: �tSfV1Ca.- <br />Data: <br />