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05/23/2011 MON 15: 53 FAX 209 667 1126 Elaokmnun Equipment 0007/029 <br /> • <br /> SAN JOAQUIN COUNTY <br /> ENWRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street,Stockton,CA 95202-3029 <br /> Telephone:(209)468-3420 F".(209)468-3433 Web:www.sieov.nrg/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(HHD) 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(I R)or Continuation Form,or <br /> disputes to any violations, are to be submitted using this certification and returned to F,HD 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 billed at <br /> the current hourly rate($122). <br /> For this certification to 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 records/other appropriate paperwork, and/or photos <br /> verifying corrections <br /> • Operator's certification <br /> Inspection Date: 5,�/// Inspected By: Stacy Rivera <br /> Facility Address:/BSS s_�fac ti EPA ID#: CSL O000tl�616- <br /> 1 certify under penalty of law that: <br /> L I have corrected the violations specified in the Inspection Report from the above-mentioned <br /> inspection date. <br /> 2. I 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 /> . Ph1otos L,,n4aperwork "S tement <br /> 3. I 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 251911)) <br /> Natrie: JCests,� Lt �eraaurtsy/u�nti Title: , tel-fCXL .. <br /> Signature: Date: s- Zp-// <br /> EHD 22-02-005 Rev 08/10 <br />