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SAN JOAQUIN COUNTY <br />ENVI)IQNMt;NTAL HEALTH I)EP RTM'ENx.- IL- <br />00 fast Main Street, Swckton, CA 9524 3*29 <br />Telephone: (209) 468-3420 Fax: (209) 458-3433 Webg <br />RETURN TO COMPLIANCE LANCE CERT1T CATION <br />A.ny MINOR violations noted in the "Notice to Comply" in the attached Itispectioit.I Yt must be <br />corrected within 3U dam of -receipt of this inspection. Thus certification forin must be su�itt�tted to the <br />Environmental Health Departtxxent (EHD) address at the top of this form within 35 days of receipt of the <br />Inc r. ertion Report_ <br />All corrections to other violations noted in the attached Inspection Report (1R) or Continuation porn, or <br />dispputes to any vio ations, are to a submitted using this certification and returned to E17LD within 30 days <br />tiZ�nless othermse speciflad in t.be. Inspection Report. <br />Note: All ERD staff time associated rvith failing to comply by the above noted dates will be billed at <br />the current hourly rate ($122)_ <br />For this certification to be GbMplete Ilii: uporatur 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/inanifests/tmining recoriWother appropriate paperwork, and/or photos <br />verifying correotiom <br />• Operator's certification <br />Inspection Date: // L Z�1& Inspected By;, -13— <br />Facility Address: QY • Aa,,.,�w2._(4 EPA TD#: <br />1 certify wider penalty of law that: <br />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 as proof of compliance FOR <br />EACH VIOLATION and I behave the information to be truer, accurate, and complete: <br />p otoc Paperwork statement <br />3_ 1 am authorized to submit this certification on behalf of the Despondent. <br />4. 1 am aware that there are significant penalties for submitting false inforniation, including the <br />passibility of a fmc and/or imprisonincat fur kuuwii violations. (HSC 2519 1) <br />Name. iS�o f1 tee ~ Title:_ r r C / ATS <br />Date: .7' <br />EHD 22-02-005 Rev 08110 <br />TO 3DVcd IQ018010D 9SSE89E60Z �Z LZ ZT.D�r`L9l'i✓8 <br />